Abstract
Introduction
In recently, Reverse shoulder arthroplasty (RSA) in patients with irreparable rotator cuff tear has been worldwidely performed. Many studies on RSA reported a good improvement in flexion of the sholulder, however, no improvement in external rotation (ER)and internal rotation motion (IR). Additionally, RSA has some risks to perform especially in younger patients, because high rates of complications such as deltoid stretching and loosening, infection, neurologic injury, dislocation, acromial fracture, and breakage of the prosthesis after long-term use were reported. Favard et al noted a 72% survival with a Constant-Murley score of <30 at 10 years with a marked break occurring at 8 years. Boileau et al noted caution is required, as such patients are often younger, and informed consent must obviously cover the high complication rate in this group, as well as the unknown longer-term outcome. Its use should be limited to elderly patients, arguably those aged over 70 years, with poor function and severe pain related to cuff deficiency. We developed a novel strategy in 2001, in which we used the humeral head to close the cuff defect and move the center of rotation medially and distally to increase the lever arm of the deltoid muscle.
Aim
The aim of this study was to investigate clinical outcome of our strategy for younger patients with an irreparable rotator cuff tear.
Materials and Methods
Eighteen shoulders (9 of male patients, 9 of female patients) of patients under 70 years old with an irreparable cuff tears and who were treated with Humeral Head Replacement (HHR) and cuff reconstruction were followed up for more than 12 months. The average age was 63.9 years (range, 58–69 years). The average follow-up period was 27.3 months (range, 12–76 months). The cuff defect was successfully closed in 8 shoulders, whereas 8 shoulders required a Latissimus Dorsi transfer; one other shoulder required a Pectralis Major transfer, and one required both Latissimus dorsi and pectoralis major transfers. Range of motion (flexion, ER), the shoulder score of Japanese Orthopaedic Association (JOA score), and complications were evaluated.
Results
Shoulder pain decreased in all patients after surgery. JOA score was improved from 41.1 to 82.6 points after surgery, Flexion motion improved from 72.5 to 145.6 degrees postoperatively and ER increased from 17.5 to 37.8 degrees postoperatively. There were no complications.
Conclusion
In our study, HHR using the small head of the humerus and cuff reconstruction for patients under 70 years old with an irreparable rotator cuff tear yielded favorable results as compared to RSA, especially in terms of the ER Furthermore, the advantages of our strategy is able to keep bone stock of the glenoid after surgery. If revision surgery is required, RSA can be performed. Since the patients included in our study were relatively active, long-term follow-up will be required to assess their progress.
