Oberflächenersatz bei Rotatorenmanschettendefektarthropathie mit erhaltener Subscapularisfunktion

Abstract

Glenohumeral arthritis with a massive rotator cuff tear is a devastating condition that seriously compromises the comfort and function of the shoulder. Cuff tear arthropathy presents a unique surgical challenge and many arthroplasty options were used for its treatment. The purpose of this study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with cuff tear arthropathy and intact subscapularis function. The study was conducted on twenty-five shoulders in twenty-five patients with cuff tear arthropathy with the subscapularis tendon still intact. The patients were prospectively followed-up clinically and radiologically for a mean of 26 months (range: 15 - 38 months). There were 16 female and 9 male patients. The mean age was 69.04 years (range: 53 - 83 years). The mean operative time was 38 minutes (range: 28 - 56 minutes). The clinical assessment was performed with the Constant score. The Constant score significantly improved from a mean of 14.04 points preoperatively to 53.17 points postoperatively. Of the patients, 88 % considered the shoulder to be much better or better as a result of the operation. Radiologically, the humeral offset, the lateral glenohumeral offset (coracoid base to the greater tuberosity), height of centre of instant rotation and the acromiohumeral distance were significantly increased. No intra- or postoperative complications were encountered. Our early results with the use of Copeland surface replacement in selected cases with cuff tear arthropathy are encouraging. The patients showed significant clinical (pain and range of motion) and radiological improvements. Moreover, if the surface replacement were to fail for any reason, it can be revised to a reverse prosthesis type as there is no lack of bone stock.