ShoulderReverse total shoulder arthroplasty for cuff tear arthropathy: the clinical effect of deltoid lengthening and center of rotation medialization
Section snippets
Materials and methods
This prospective cohort study included 49 consecutive patients who underwent RSA for cuff tear arthropathy from January 2004 to October 2009. Twelve patients were excluded, leaving 37 patients (10 men, 27 women) with complete follow-up who were included in the analysis. Four surgeons at a single institution implanted 27 Zimmer trabecular metal reverse shoulder system prostheses (Zimmer Inc, Warsaw, IN, USA), 7 Delta III reverse shoulder system prosthesis (DePuy Orthopedics, Warsaw, IN, USA),
Results
At final follow-up (16 ± 10 months), all patients reported subjective improvements in function and pain relief (Table I). Postoperatively, the average ASES score improved nearly 44 points, and the average SST score improved 5.4 points. ROM results are summarized in Table II. Active forward elevation increased from 38° ± 26° preoperatively to an average of 144° ± 19° postoperatively. External rotation at the side significantly increased from 10° ± 14° preoperatively to 23° ± 16°. The improvement
Discussion
With the clinical success3, 4, 10, 19, 35, 44 of contemporary semiconstrained reverse shoulder prostheses beginning with the Grammont Delta prosthesis,14 there has been a popularity shift away from cuff tear arthropathy hemiarthroplasty because of the limited functional outcomes and poor durability of pain relief.9, 27, 32, 46 Central to the functional success of the RSA is the nonanatomic biomechanics and improved effectiveness of the deltoid to restore shoulder function in the face of a
Conclusion
This study’s main finding that deltoid lengthening increases forward elevation is clinically significant because it prioritizes deltoid lengthening intraoperatively. The determination of lengthening and implant stability are mostly subjective intraoperative findings, although comparing preoperative radiographs with the contralateral humerus24 may help estimate restoration of normal arm length in complex revision or fracture sequelae cases with significant bone loss. In the setting of cuff tear
Disclaimer
This research was supported by OREF Resident Educational Grant (# 07-084) awarded to G.D. Brown.
Dr Bigliani received a lump sum royalty from Zimmer Inc and will not personally receive additional royalties from Zimmer Inc. Drs Bigliani, Levine, and Ahmad, and Mr Gardner receive institutional research support from Zimmer Inc. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any
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This study was approved by the Columbia University Institutional Review Board (Approval No. AAAC-0180).