Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis.

摘要

BACKGROUND: The purpose of the present study was to evaluate the indications for, and outcomes of, reverse shoulder arthroplasty in patients with massive rotator cuff tears but without glenohumeral arthritis. METHODS: From December 1998 to December 2006, sixty-nine patients (seventy-two shoulders) were managed with reverse shoulder arthroplasty for the treatment of irreparable rotator cuff dysfunction without glenohumeral arthritis. The indications for reverse shoulder arthroplasty were persistent shoulder pain and dysfunction despite a minimum of six months of nonoperative treatment, the presence of at least a two-tendon tear, and Hamada stage-1, 2, or 3 changes in a patient for whom a non-arthroplasty option did not exist. Fifty-eight patients (sixty shoulders) had a minimum of two years of follow-up. Thirty-four shoulders had had no previous surgery (Group A), and twenty-six shoulders had had at least one previous surgical procedure (Group B). Postoperatively, patients were prospectively followed both clinically and radiographically. Survival analysis was performed, with the end points being removal or revision of the implant, radiographic loosening, and declining American Shoulder and Elbow Surgeons score. RESULTS: Common characteristics of patients managed with reverse shoulder arthroplasty in this study were pain and (1) <90 degrees of arm elevation at the shoulder without anterosuperior escape (n = 40; 66.6%); (2) <90 degrees of elevation with anterosuperior escape (n = 16; 26.7%); or (3) irreparable rotator cuff tear and pain with >90 degrees of elevation (n = 4; 6.7%). The average duration of follow-up was fifty-two months (range, twenty-four to 101 months). All measured outcomes improved postoperatively. For all patients, the average American Shoulder and Elbow Surgeons score improved from 33.3 to 75.4 (p < 0.0001), the average Simple Shoulder Test score improved from 1.6 to 6.5 (p < 0.0001), the average visual analog score for pain improved from 6.3 to 1.9 (p < 0.0001), the average visual analog score for function improved from 3.2 to 7.1 (p < 0.0001), the average forward flexion improved from 53 degrees to 134 degrees (p < 0.0001), the average abduction improved from 49 degrees to 125 degrees (p < 0.0001), the average internal rotation improved from S1 to L2 (p < 0.0001), and the average external rotation improved from 27 degrees to 51 degrees (p = 0.001). There were a total of twelve complications in eleven patients (prevalence, 20%). The survivorship at a mean of fifty-two months (range, twenty-four to 101 months) was 90.7% for all patients, 91.8% for Group A, and 87% for Group B. CONCLUSIONS: When non-arthroplasty options either have failed or have a low likelihood of success, reverse shoulder arthroplasty provides reliable pain relief and return of shoulder function in patients with massive rotator cuff tears without arthritis at the time of short to intermediate-term follow-up.