rotator cuff based primarily on increasing age. There is a general agreement that an ATSA requires an intact and functioning rotator cuff for a successful outcome. There is also a general agreement that as patients age, there is concurrent rotator cuff degeneration. There are situations in which a “structurally” intact rotator cuff may not be “functionally” intact, particularly after the manipulation that occurs during a shoulder arthroplasty. We have certainly encountered patients with ATSA, who at the time of surgery clearly had a structurally intact rotator cuff. However, postoperatively, these patients are unable to regain active range of motion and present with the clinical appearance of rotator cuff deficiency. This generally occurs in older patients in their 70s and 80s, and this situation has led to the question of whether RTSA is preferred for patients with osteoarthritis with an intact rotator cuff based solely on advancing age (FIGURE 7.2).
FIGURE 7.2 A, A 92-year-old woman with osteoarthritis of the left glenohumeral joint. B, Reverse total shoulder arthroplasty performed based primarily on patient age and potential for associated rotator cuff compromise.
TABLE 7.1 Age Distribution of 2940 ATSAs and RTSAs for Glenohumeral Osteoarthritis With an Intact Rotator Cuff in 3-Year Increments. RTSA Becomes More Commonly Utilized Beginning in the 76- to 79-Year Age Group
These results with RTSA are sustained over long-term follow-up as Gerber et al recently reported. For 22 CTA patients treated with RTSA and a minimum 15 year follow-up, forward elevation improved from 53° to 101° and abduction improved from 55° to 86°.19 Furthermore, RTSA for CTA has been noted to have greater improvement compared to RTSA performed for other glenohumeral pathologies.16,17,20 For CTA, RTSA is clearly the preferred arthroplasty option (FIGURE 7.3).