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

Figure 1 - Humeral head articulating with the coracoacromial arch
Figure 1 - Humeral head articulating with the coracoacromial arch

About cuff tear arthropathy

Basics 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.