Rotator Cuff Reconstruction and Humeral Head Replacement Using Smaller Humeral Prostheses in Cuff Tear Arthropathy Patients under 70 Years of Age

摘要

Background: Most reverse shoulder arthroplasty (RSA) studies have shown good improvement in arm elevation without improvements in external rotation (ER). In addition, high rates of complications after long-term RSA have been reported, suggesting that RSA should be limited to elderly patients, especially those who are older than 70 years old. Since 2001, we have developed a strategy of rotator cuff reconstruction with muscle transfer and humeral head replacement (HHR), using smaller humeral prostheses, in cuff tear arthropathy patients. The aim of the present study was to investigate the clinical outcome of our strategy in patients under 70 years of age who had irreparable rotator cuff tears and osteoarthritis. Materials and Methods: A total of 25 shoulders of 25 patients under 70 years of age (males, 15;females, 10) with irreparable cuff tears were treated with HHR and cuff reconstruction. The average age at the time of surgery was 64.3 years (range, 55 - 69) and the average follow-up period was 38.7 months (range, 24 - 72). The cuff defect was repaired using a partial subscapularis transfer in 14 shoulders;nine shoulders required a latissimus dorsi transfer, one required a pectoralis major transfer, and one required both a latissimus dorsi and a pectoralis major transfer. Clinical outcomes were assessed with the range of motion (ROM), UCLA score, Japanese Orthopaedic Association (JOA) score and postsurgical complications. Results: Shoulder pain was diminished in all patients after surgery. The preoperative UCLA and JOA scores were 13.1 and 47.0 respectively, improving to 28.6 and 81.5 respectively after surgery. Active forward flexion has improved from an average of 89.0° to 138.8°, and the ER improved from an average of 16.2° to 33.2°. No complications occurred after surgery. Conclusion: Anatomical reconstruction using smaller head humeral prostheses yielded favorable results and less complication, compared with RSA. Considering another advantage of ability to retain glenoid bone stock, the current procedure can be a useful option for irreparable rotator cuff tears with OA in patients under 70 years old.