Bipolar hemiarthroplasty for chronic rotator cuff tear arthropathy

Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
The Journal of Arthroplasty (Impact Factor: 2.37). 03/2003; 18(2):169-73. DOI: 10.1054/arth.2003.50041
Source: PubMed

ABSTRACT Massive rotator cuff tears associated with glenohumeral arthritis are currently an unsolvable clinical entity. We review our series of 14 patients with rotator cuff tear arthropathy (RCTA) who underwent a bipolar prosthesis of the shoulder. The average follow up was 27.8 months (range, 24-48 months), and the average age was 71 years (range, 57-84 years). Of these 14 patients, 9 were men and 5 women. None of these patients had undergone previous shoulder surgery, and all patients underwent conservative treatment that failed to improve their symptoms or range of motion. Preoperatively, the average active forward flexion was 30 degrees, active external rotation was 10 degrees, and the American Shoulder and Elbow Society (ASES) score was 25 points. Postoperatively, the average active forward flexion improved to 88 degrees, active external rotation increased to 37 degrees, and the ASES score improved to 80 points. Of the 14 patients, 12 stated that they had no pain with activities of daily living. Two patients continued to have moderate pain in everyday activity.

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    ABSTRACT: Cuff tear arthropathy represents a special type of arthritis accompanying massive cuff tears. It is characterized by proximal migration of the humeral head and articulation of the humeral head against the acromion. Traditional shoulder arthroplasty designs have not addressed this humeral-acromial articulation and may be one of the reasons traditional arthroplasty has not worked as well with these patients. A new design based on the adaptive changes seen in cuff tear arthropathy is presented. Rather than trying to force the humeral head to stay centered in the glenoid, this new device accepts the proximal migration of the humerus and seeks to maximize the efficiency of the humeral-acromial articulation and thereby improve the efficiency of the deltoid. Significant improvement in function, pain, motion and patient satisfaction has been achieved with this device with minimal complications. It has performed well in all cases of cuff tear arthropathy with the exception of those patients who have superior escape.
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    ABSTRACT: Cuff tear arthropathy (CTA) is a shoulder pathology characterized by a massive and irreparable rotator cuff tear and an abnormal contact between the humeral head and the acromion. CTA is often associated with shoulder pseudo-paralysis. However, the fact that some patients still maintain a functional shoulder remains unexplained. The goal of the present work was to numerically assess the biomechanical parameters that influence the function of the shoulder with CTA. The specific objectives were to show the influence of: (1) a variation of the medial offset of the proximal humerus on the destabilizing forces at the intact (healthy) shoulder; (2) the elevation plane and the friction coefficient on the “mechanics of CTA” and; (3) the geometrical parameters of the humeral head on the “mechanics of CTA” in the context of an hemiarthroplasty. Study #1 assessed the influence of a minimum (0 mm), average (7 mm) and maximum (14 mm) medial offset on the destabilizing glenohumeral forces (transverse to the glenoid) at the intact (healthy) shoulder. Study #2 assessed the influence of the elevation plane (frontal, scapular, sagittal) and the contact friction (coefficient of 0.15, 0.3 and 0.6) on the “mechanics of CTA” (i.e. deltoid length and force; contact forces (glenoid and acromion)). Study #3 assessed the influence of a large medial offset (17 mm) associated with an oversized humeral head hemiprosthesis (120 %) on the same “mechanics of CTA” as in study #2. Study #1 showed that the maximum medial offset (14 mm) greatly decreases the destabilizing action of the deltoid without affecting the stabilizing action of the rotator cuff. The CTA model of study #2 showed that the elevation plane influences the mechanics of CTA, but that the contact condition (friction) combined with the poor mechanics of the deltoid is more likely to lead to a poor function. Study #3 showed that the combination of a large medial offset with an oversized humeral head hemiprosthesis decreases the acromio-humeral contact force and increases the range of motion more significantly compared to a simple oversized prosthetic head. The present work highlights the potential of the AnyBody software to study the sensitivity of the human musculoskeletal system (intact and injured) to morphological parameters. This work also brings new lines of thoughts regarding biomechanical parameters that influence the function of the shoulder with CTA. Finally, this work proposes an oversized humeral hemiprosthesis with a large medial offset as an alternative CTA treatment for young patients with poor function, thus leaving more room for revision surgery.
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    ABSTRACT: Rotator cuff arthropathy is a specific and uncommon disease entity. It affects mainly elderly, but often active people. The exact causes are not known, but there is evidence of genetic predisposition, crystal disease and mechanical factors. There are numerous treatment options for both the pain and dysfunction. Generally, non-operative measures are successful, if used appropriately and timely. Arthroscopic debridement and washout alone has only short-term benefit, but arthroscopic biceps tenotomy or tenodesis is effective in eliminating pain caused by long head of biceps tendon pathology. Anatomical hemi-arthroplasty, whether stemmed or surface replacement, primarily improves pain. However, modern designs specifically for cuff tear arthropathy have shown improved functional results. Surface replacement implants also confer the benefits of being less invasive and of preserving bone. Reverse total shoulder arthroplasty is a powerful tool for the elderly patient with unresponsive painful pseudoparalysis. However, it has a high complication rate and should be used with care.
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