Cuff tear arthropathy - CTA - prosthesis for shoulder arthritis: Surgery with a cementless CTA prosthesis can lessen pain and improve function in shoulders with the combination of arthritis and rotator cuff tears.

Edited By: Winston J. Warme, MD, Frederick A. Matsen III, M.D.
Last updated Monday, October 09, 2006

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Summary

What are the key points about shoulder joint replacement surgery with a rotator cuff tear arthropathy (cta) prosthesis for rotator cuff tear arthropathy (arthritis with a massive rotator cuff tear)?

Rotator cuff tear arthropathy (arthritis with a massive rotator cuff tear) is a devastating condition that seriously compromises the comfort and function of the shoulder. This condition is characterized by the permanent loss of the rotator cuff tendons and the normal surface of the shoulder joint. These tissues cannot be restored to their normal condition and the lost comfort and function of the shoulder cannot be totally regained. However, in the hands of an experienced surgeon and in a well-motivated individual, shoulder replacement surgery with a cuff tear arthropathy (CTA) head prosthesis along with post-surgical rehabilitation can help restore substantial comfort and function to shoulders damaged by cuff tear arthropathy.

When the rotator cuff is essentially intact, shoulder arthritis is often best treated by total shoulder replacement.

Consultation by the Shoulder and Elbow Service at the University of Washington regarding the diagnosis and treatment of shoulder arthritis may be requested by using our online referrals website.

You can also call 206-598-0312 to make an appointment.

More detail about shoulder arthritis with a massive rotator cuff tear and the treatment options can be found below.

In the normal shoulder, the rotator cuff muscles, including the supraspinatus, help balance the ball of the arm bone (humeral head) in the socket against the upward pull of the deltoid muscle. [Figure 1].

In rotator cuff tear arthropathy, the rotator cuff tendons that normally are interposed between the humeral head and the overlying coracoacromial arch become progressively thinned until the humeral head moves upwards and rubs against the bone of the arch. [Figure 2].

In stage 1A of rotator cuff tear arthropathy the humeral head remains centered in the socket (glenoid) in spite of a large rotator cuff tear [Figure 3]. In stage 1B of rotator cuff tear arthropathy the humeral head migrates medially into the socket (glenoid) [Figure 4]. In stage 2A of rotator cuff tear arthropathy the humeral head migrates upwards, but is stabilized by the overlying coracoacromial arch in spite of the lack of rotator cuff. [Figures 5 and 6]. In stage 2B of rotator cuff tear arthropathy the humeral head migrates upwards and forwards because it is no longer stabilized by the coracoacromial arch. This condition often arises after previous procedures such as an acromioplasty when it is performed in the presence of a large cuff tear. [Figure 7]

After performing a clinical exam, a shoulder surgeon experienced with rotator cuff tear arthropathy can suggest what type of surgery is most likely to be helpful to the individual with the condition. Individuals are most likely to benefit from this surgery if they are well motivated and in good health.

Shoulders demonstrating changes of Stages 1A, 1B, and 2A with substantial loss of comfort and function are considered for shoulder arthroplasty using a cuff tear arthropathy (CTA) prosthesis as described in this article.

Shoulders with stage 2B cuff tear arthropathy with substantial loss of comfort and function are considered for the reversed (reverse Delta) prosthesis because the cuff tear arthropathy (CTA) prosthesis may not provide sufficient stability for the humeral head (ball of the shoulder joint). The reversed (reverse Delta) prosthesis is designed with a socket where the ball (head of the humerus) is normally located and a ball where the socket (glenoid) is usually located.

The goal of shoulder replacement arthroplasty with a cuff tear arthropathy (CTA) prosthesis is to restore the best possible function to the joint by removing scar tissue, balancing muscles, and replacing the destroyed joint surface of the humerus (arm bone) [figure 8] with an artificial one especially designed for that purpose [figure 9]. The humeral ball is fixed to the humerus (arm bone) by press fitting its stem inside the bone.

Shoulder joint replacement arthroplasty with a cuff tear arthropathy head is a highly technical procedure and is best performed by a surgical team who performs this surgery often. Such a team can maximize the benefit and minimize the risks.

The two-hour procedure is performed under general (or nerve block) anesthesia. Shoulder motion is started immediately after the procedure. Individuals having this procedure learn to do their own physical therapy and are usually discharged three days after surgery if they are comfortable and have a good range of passive motion. The recovery of strength and function may continue for up to a year after surgery.

Surgery for Rotator cuff tear arthropathy (arthritis with a massive rotator cuff tear) at the University of Washington

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