Arthroplasty in Cuff Tear Arthropathy: Surgery for shoulders with a rotator cuff tear and arthritis can lessen shoulder pain and improve function with joint replacement.
Last updated Wednesday, January 26, 2005
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Figure 1 - Humeral head articulating with the coracoacromial arch About cuff tear arthropathyBasics of rotator cuff tear arthropathy (shoulder Rotator cuff tear arthropathy (or shoulder arthritis with a large
rotator cuff tear) is a severe and complex form of shoulder arthritis
in which the shoulder has lost not only the cartilage that normally
covers its joint surface, but also the tendons of the rotator cuff tear
which help position and power the joint.
Normally, the tendons of the rotator cuff (large arrows) allow
smooth motion of the upper end of the arm bone (humerus) beneath the
overlying bones and muscles.
When the rotator cuff is degenerated, chronically torn or otherwise
deficient, the normally smooth upper surface of the upper end of the
arm bone (humeral head) is unprotected from rubbing with the
undersurface of the bone and ligaments above.
In cuff tear arthropathy, the upper surface of the ball of the upper
arm bone (humeral head) becomes roughened as it rubs against the
overlying bone (the acromion). This condition results in shoulder pain,
weakness, stiffness and grinding on movement.
Treatment options for cuff tear arthropathy include partial joint replacement with a cuff tear arthropathy (CTA) prosthesis. If severe instability of the joint complicates cuff tear arthropathy, a reversed (reverse Delta) prosthesis may be indicated. Surgical details The bone is smoothed so that it is congruous with the joint surface.
This allows for the proximal humerus to match the cup and to articulate
smoothly within it. It is very important to avoid using "oversized"
humeral components, because they overstuff the joint, do not match the
concavity of the cup, and restrict joint motion. In a special
hemiarthroplasty, the patient is spared the necessity of protecting a
rotator cuff repair, so that immediate passive and active exercises can
be started after surgery. The patient is also spared the risk of
glenoid loosening.Ideal patient The ideal patient for this procedure has a normal deltoid muscle, a
concentric socket, concentric erosion of the upper glenoid fossa, a
smoothed upper humerus with rounding off of the greater tuberosity, an
irreparable rotator cuff defect, no previous surgery of the acromion or
coracoacromial ligament, good patient motivation, and realistic
expectations.Effectiveness In a series of ten patients having special hemiarthroplasty for rotator
cuff tear arthropathy, the range of active flexion improved from 71 to
115 degrees following this procedure. In comparison to their function
before surgery, 7 more could care for their perineum, reach their
opposite axilla, and sleep on their affected side and 6 more could comb
their hair and use the hand above shoulder level.
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