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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About the procedure

Technical details

Shoulder replacement surgery for cuff tear arthropathy is a highly technical procedure; each step plays a critical role in the outcome.

After the anesthetic has been administered and the shoulder is prepared, an incision is made across the front of the shoulder from the middle of the collarbone to the middle of the arm bone as shown in the figure. [Figure 19] This incision allows access to the joint without damaging the important deltoid or pectoralis muscles that are responsible for a significant portion of the shoulder's power. Opening the shoulder reveals the irregular joint surface of the humeral head and the intact subscapularis muscle. [Figure 20] The tendon of the subscapularis muscle is cut to gain access to the joint and released circumferentially (a 360-degree release) to restore its length and mobility.[Figure 21 ]. The arthritic humeral head (ball of the joint) is removed and the shaft of the bone prepared to receive the stem of the humeral component. [Figure 22]. In rotator cuff tear arthropathy, a specially shaped humeral head prosthesis is used to cover the entire upper end of the humerus (arm bone). [Figure 23]. Special instruments are used to customize the arm bone (humerus) to fit this component [Figures 24-28]

This prosthesis provides a smooth surface in both rotation and elevation of the arm [Figure 29 and 30] and that allows a greater range of motion than what is allowed by a conventional humeral head prosthesis [Figure 31]

The humeral component is made of metal and is usually press fit, but sometimes cemented, into the shaft of the bone of the humerus. [Figure 32]

The socket of the joint is usually not replaced in cuff tear arthropathy because of the substantially increased incidence of glenoid component loosening and failure in this condition.

At the conclusion of this procedure, the subscapularis tendon is securely repaired to the bone. [Figures 33 and 34] is repaired and requires protection from active use for at least 6 weeks while it is healing.

X-rays are taken to document the position and orientation of the prosthesis. [Figure 35]

Anesthetic

Length of shoulder joint replacement surgery with a rotator cuff tear arthropathy (cta) prosthesis

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

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