Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency

  • Cuff D
  • Pupello D
  • Virani N
 et al. 
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Abstract

Background: Early designs of reverse shoulder arthroplasty components
for the treatment of glenohumeral arthritis

associated with severe rotator cuff deficiency in some cases have
been associated with mechanical failure. The purpose

of this study was to perform a prospective outcomes study of reverse
shoulder arthroplasty performed with use of

5.0-mm peripheral locking screws for baseplate fixation and a lateralized
center of rotation for the treatment of a rotator

cuff deficiency.

Methods: From February 2004 to March 2005, 112 patients (114 shoulders)
were treated with a reverse shoulder

arthroplasty as part of a United States Food and Drug Administration
Investigational Device Exemption study. Ninetyfour

patients (ninety-six shoulders) were available for a minimum follow-up
of two years. Of the ninety-six shoulders,

thirty-seven had a primary rotator cuff deficiency, thirty-three had
a previous rotator cuff operation, twenty-three had a

previous arthroplasty, and three had a proximal humeral nonunion.
The patients were prospectively followed clinically

(the American Shoulder and Elbow Surgeons [ASES] score, the Simple
Shoulder Test [SST], and self-reported satisfaction)

and radiographically (mechanical failure, loosening, and notching).
Patients were videotaped while performing a

standard active range-of-motion protocol before and after treatment.
These videos were then analyzed in a blinded

fashion by three independent observers using a digital goniometer.

Results: At two years, the average total ASES scores had improved
from 30 preoperatively to 77.6; the average ASES

pain scores, from 15 to 41.6; and the average SST scores, from 1.8
to 6.8 (p < 0.0001 for all). Blinded analysis of

range of motion showed that average abduction improved from 61 preoperatively
to 109.5 (p < 0.0001); average

flexion, from 63.5 to 118 (p < 0.0001); and average external rotation,
from 13.4 to 28.2 (p < 0.0001). The patients

rated the outcome as excellent in fifty-three shoulders (55%), good
in twenty-six (27%), satisfactory in eleven (12%), and

unsatisfactory in six (6%). There was no evidence of mechanical failure
of the baseplate or scapular notching in any of

the patients. Six of the ninety-four patients in this study had a
complication.

Conclusions: Recent advances in reverse shoulder arthroplasty have
allowed for improvement in patient outcomes

while minimizing early mechanical failure and scapular notching and
decreasing the overall complication rate at shortterm

follow-up.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors
for a complete description of levels of evidence.

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Authors

  • Derek Cuff

  • Derek Pupello

  • Nazeem Virani

  • Jonathan C Levy

  • Mark Frankle

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