Outpatient Treatment of Compensated Cuff Arthropathy Using Inlay Arthroplasty With Subscapularis Preservation

Abstract

Management of the rotator cuff–deficient shoulder remains challenging particularly for younger patients with higher functional demands. Patients presenting with signs and symptoms of cuff tear arthropathy (CTA) are frequently treated with reverse, total, or hemishoulder arthroplasty. Life expectancy must be taken into consideration when deciding on the treatment path for high-demand patients, particularly in light of significant complication rates and poor revision strategies for reverse shoulder arthroplasty. Subsets of patients presenting with early CTA stage IA (Seebauer Classification, Burkhart type I) are suitable candidates for a less-invasive approach. Intact fulcrum kinematics provide a compensated, deltoid-driven functional improvement when primary and secondary pain generators are addressed. Over the past 7 years, we have followed strict stage-specific selection criteria and treated these patients with a humeroacromial inlay arthroplasty (HemiCAP), which preserves the congruity of the articular surface with minimal bone resection and leaves a clinical exit strategy into total shoulder arthroplasty or hemishoulder arthroplasty if necessary. The procedure allows for a deltoid-splitting approach leaving the subscapularis untouched. This has positive implications for postoperative recovery and prevents possible approach-related complications associated with a subscapularis tenotomy. Patient selection, technical aspects, and adjuvant procedures play an important role and make superior humeral head inlay arthroplasty a safe, effective, and reproducible joint-preserving solution for early-stage compensated CTA.