11 Treating the Rotator Cuff–Deficient Shoulder: The Mayo Clinic Experience There has been an evolution in the treatment of rotator cuff arthropathy (RCA) at the Mayo Clinic (Rochester, MN). There was a brief experience with constrained and semiconstrained designs in the 1970s and 1980s. However, the predominant treatment for the last 25 years has been hemiarthroplasty. Recently, there has been incorporation of a reverse prosthesis design for the treatment of select patients with cuff tear arthropathy (CTA). Our purpose in this chapter is to discuss the Mayo Clinic experience in treating RCA with shoulder arthroplasty. The results, risk factors for an unsatisfactory outcome, and rates of failure will be reviewed. In the late 1970s, there was recognition of a group of patients who had destruction of glenohumeral cartilage in association with severe RC tearing. This was often associated with instability as well as some degree of bone loss. Neer and coworkers1 have described a CTA to better characterize this syndrome. In 1986, Brownlee and Cofield reported on 20 shoulder replacements performed for CTA between 1976 and 1982.2 Sixteen shoulder arthroplasties were available for review at a mean of 4 years following surgery. A humeral head replacement without a glenoid component was performed in four shoulders. In these patients, there was a reduction of pain in all shoulders, but there was little change in active motion. There were no reoperations among these four shoulders. However, in the remaining 12 shoulders that had placement of a glenoid component, revision was needed for glenoid component problems in three shoulders. This group was reviewed in 1991, and no substantive changes had occurred over time.3 The results of shoulder hemiarthroplasty for RCA at the Mayo Clinic in a series of 33 shoulders, followed for an average of 5 years, was recently reviewed by Sanchez-Sotelo and colleagues.4 Eleven shoulders had undergone between one and four previous procedures, including an acromioplasty in eight shoulders. Shoulder hemiarthroplasty was associated with significant pain relief (Fig. 11–1 and Fig. 11–2). However, at the most recent follow-up, 9 patients (27%) had moderate pain at rest or pain with activity. The mean active elevation improved from 72 to 91 degrees (p = 0.008), mean internal rotation improved from L3 to L1 (p = 0.02), and mean active external rotation improved from 36 to 41 degrees (not significant). According to Neer’s limited goals criteria, successful results were achieved in 22 cases (67%). However, most patients were satisfied with the outcome of the surgery and only four shoulders were subjectively considered to be the same or worse than before the operation. Two factors were associated with a less satisfactory outcome: prior subacromial decompression and the extent of proximal migration of the humeral head. The experience with hemiarthroplasty for RCA revealed that a less satisfactory outcome should be expected in patients with prior violation of the coracoacromial arch. The use of either small humeral head sizes in an attempt to facilitate reconstruction of the cuff or large sizes to maximize joint stability did not seem to be justified.
Hemiarthroplasty (Humeral Head Replacement)
Related posts:
The Spectrum of Disease in the Rotator Cuff–Deficient Shoulder
Muscle Transfers for the Treatment of the Irreparable Rotator Cuff Tear
Classification of Rotator Cuff– Tear Arthropathy
Rationale and Biomechanics of the Reversed Shoulder Prosthesis: The French Experience
Arthroscopic Management of Massive Rotator Cuff Tears
Treating the Rotator Cuff–Deficient Shoulder: The Florida Orthopaedic Institute Experience
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