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J Shoulder Elbow Surg. 2013 Jan;22(1):e1-7. doi: 10.1016/j.jse.2012.04.006. Epub 2012 Jun 26.

Treatment of severe cuff tear arthropathy with the humeral head resurfacing arthroplasty: two-year minimum follow-up.

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  • 1Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg, Germany. guido.pape@med.uni-heidelberg.de

Abstract

BACKGROUND:

The aim of the study was to evaluate the outcome of a humeral head resurfacing arthroplasty implanted toward valgus for patients with cuff tear arthropathy (CTA).

MATERIALS AND METHODS:

We monitored 24 patients with CTA who underwent resurfacing arthroplasty. Patients were assessed with use of the Constant score and a subjective satisfaction score. The rotator cuff was evaluated preoperatively by magnetic resonance imaging. The Sirveaux classification of glenoid erosion in glenohumeral osteoarthritis with massive rupture of the cuff was used to grade the preoperative status of the glenoid.

RESULTS:

The mean absolute Constant score for the entire cohort improved from 21 points (range, 7-44 points) to 63 points (range, 23-89 points) at a mean of 38 months (range, 24-56 months). Patients with an intact or moderately atrophied teres minor muscle (n = 16) showed a significantly better Constant score (P = .011) and greater active external rotation (P = .034) than patients with severe atrophy. Neither the type of glenoid erosion according to Sirveaux nor the inclination angle of the implant has an effect on the clinical or functional outcome.

CONCLUSIONS:

For selected patients with CTA, resurfacing arthroplasty of the humeral head provides satisfactory medium-term outcomes. The teres minor muscle is necessary for maintaining or establishing external rotation. In patients with massive limitation of motion and total absence of the subscapularis tendon, the implantation of a humeral surface replacement should be seriously considered.

Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

PMID:
22743073
[PubMed - indexed for MEDLINE]
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