Reverse shoulder arthroplasty for massive irreparable rotator cuff tears: a reliable treatment method

Abstract

BackgroundMassive irreparable rotator cuff tears (MIRCT) are challenging problems for both patients and surgeons. Reverse total shoulder arthroplasty (RTSA) is a treatment option for patients with MIRCTs. However, previous reports have shown inconsistent results, varying patient satisfaction, and higher complication rates. MethodsThis is a retrospective multi-institutional study (22 institutions, 24 surgeons) of 203 patients (average age, 71 years) who underwent RTSA for MIRCT without glenohumeral arthritis with a mean follow-up of 50 months. Patients were divided into 4 groups based on preoperative shoulder active forward elevation (aFE) (<60°, <90°, ≥90°, >120°). Clinical outcomes were assessed using multiple patient-reported outcome measures (PROs), postoperative range of motion (ROM), patient satisfaction, and complication rate. Radiographic outcomes assessment included evaluation of postoperative scapular notching and humeral radiolucent lines. ResultsPatients in each group had significant (P≤ 0.02) improvements in PROs and ROM postoperatively. Patient satisfaction was highest in the group with >120° preoperative aFE (44/44, 100%). Scapular notching and humeral radiolucency were noted in 6% and 7% of patients, respectively. There were only 3 complications that required 2 revision surgeries. Overall, the complication rate (1.6%) and reoperation rate (1.1%) were considerably lower than previously reported. ConclusionRTSA is a reliable treatment for MIRCTs without glenohumeral arthritis that results in significant improvements in PROs and shoulder ROM. Compared to previous studies, we report a substantially higher satisfaction rates in all patients, especially in those with better preoperative ROM (aFE >120°), and a lower overall complication rate. Level of evidenceLevel IV, retrospective case series.