Clinical effectiveness and safety of the extended humeral head arthroplasty for selected patients with rotator cuff tear arthropathy.

Abstract

BACKGROUND:

Cuff tear arthropathy is commonly managed with a reverse total shoulder arthroplasty (RTSA). A humeral hemiarthroplasty with an extended humeral head may provide a less invasive alternative for selected patients with cuff tear arthropathy if the shoulder has preserved active elevation. Because evidence regarding this procedure is limited, we investigated its safety and efficacy in treating selected patients with cuff tear arthropathy.

METHODS:

We analyzed the preoperative characteristics, surgical findings, and clinical outcomes for patients selected for extended head hemiarthroplasty.

RESULTS:

For 42 patients with 2-year follow-up, there were no complications or revisions. The Simple Shoulder Test score improved from a median of 3.0 to 8.0 (P < .001). The median percentage of maximal possible improvement was 50% (P < .001). The percentage of patients able to perform each of the functions of the Simple Shoulder Test was significantly improved; for example, the ability to sleep comfortably increased from 19% to 71%, and the ability to place a coin on the shelf at shoulder level increased from 38% to 86% (P < .001).

CONCLUSIONS:

There are circumstances in which RTSA is clearly the preferred procedure for cuff tear arthropathy, including pseudoparalysis, anterosuperior escape, and glenohumeral instability; however, in shoulders with preserved active motion and stability of the humeral head provided by an intact coracoacromial arch, the extended head humeral arthroplasty can enable selected patients to realize improved comfort and function without the potential risks of RTSA. Extended humeral head hemiarthroplasty can provide a safe and effective alternative for the management of selected patients with rotator cuff tear arthropathy and preserved active motion.

• Authors: Frederick A Matsen 3rd, Jeremy S Somerson, Jason E Hsu, Steven B Lippitt, Stacy M Russ, Moni B Neradilek
• Journal: Journal of shoulder and elbow surgery (J Shoulder Elbow Surg) Vol. 28 Issue 3 Pg. 483-495 (Mar 2019) ISSN: 1532-6500 [Electronic] United States
• PMID: 30392935 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Hemiarthroplasty (adverse effects, methods)
• Humans
• Humeral Head (surgery)
• Male
• Middle Aged
• Patient Selection
• Rotator Cuff Injuries (physiopathology, surgery)
• Rotator Cuff Tear Arthropathy (physiopathology, surgery)
• Shoulder Joint (physiopathology, surgery)
• Treatment Outcome