Managing rotator cuff tear arthropathy: a role for cuff tear arthropathy hemiarthroplasty as well as reverse total shoulder arthroplasty.

Autor: Stenson JF; Orthopedic Surgery, Einstein Healthcare Network, Albert Einstein Medical Center, Philadelphia, PA, USA., Mills ZD; Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA., Dasari SP; Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA., Whitson AJ; Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA., Hsu JE; Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA., Matsen FA 3rd; Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA. Electronic address: matsen@uw.edu.
Jazyk: angličtina
Zdroj: Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2024 Mar; Vol. 33 (3), pp. e162-e174. Date of Electronic Publication: 2023 Jul 18.
DOI: 10.1016/j.jse.2023.06.014
Abstrakt: Background: Disabling cuff tear arthropathy (CTA) is commonly managed with reverse shoulder arthroplasty (RSA). However, for patients with CTA having preserved active elevation, cuff tear arthropathy hemiarthroplasty (CTAH) may offer a cost-effective alternative that avoids the complications unique to RSA. We sought to determine the characteristics and outcomes of a series of patients with CTA managed with these procedures.
Materials and Methods: We retrospectively reviewed 103 patients with CTA treated with shoulder arthroplasty, the type of which was determined by the patient's ability to actively elevate the arm. Outcome measures included the change in the Simple Shoulder Test (SST), the percent maximum improvement in SST (%MPI), and the percentage of patients exceeding the minimal clinically important difference for the change in SST and %MPI. Postoperative x-rays were evaluated to assess the positions of the center of rotation and the greater tuberosity for each implant.
Results: Forty-four percent of the 103 patients were managed with CTAH while 56% were managed with RSA. Both arthroplasties resulted in clinically significant improvement. Patients having RSA improved from a mean preoperative SST score of 1.7 (interquartile range [IQR], 0.0-3.0) to a postoperative score of 6.3 (IQR, 2.3-10.0) (P < .01). Patients having CTAH improved from a preoperative SST score of 3.1 (IQR, 1.0-4.0) to a postoperative score of 7.6 (IQR, 5.0-10.) (P < .001). These improvements exceeded the minimal clinically important difference. Instability accounted for most of the RSA complications; however, it did not account for any CTAH complications. The postoperative position of the center of rotation and greater tuberosity on anteroposterior radiographs did not correlate with the clinical outcomes for either procedure.
Conclusion: For 103 patients with CTA, clinically significant improvement was achieved with appropriately indicated CTAH and RSA. In view of the lower cost of the CTAH implant, it may provide a cost-effective alternative to RSA for patients with retained active elevation.
(Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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