Rotator Cuff Reconstruction and Humeral Head Replacement Using Smaller Humeral Prostheses in Cuff Tear Arthropathy Patients under 70 Years of Age

Naoki Miyoshi¹, Naoki Suenaga², Naomi Oizumi², Noboru Taniguchi³, Hiroshi Ito¹

¹Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan.
²The Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Hospital, Sapporo, Japan.
³Department of Orthopaedic Surgery, Miyazaki University, Miyazaki, Japan.

DOI: 10.4236/ojo.2014.410043                

Abstract

Background: Most reverse shoulder arthroplasty (RSA) studies have shown good improvement in arm elevation without improvements in external rotation (ER). In addition, high rates of complications after long-term RSA have been reported, suggesting that RSA should be limited to elderly patients, especially those who are older than 70 years old. Since 2001, we have developed a strategy of rotator cuff reconstruction with muscle transfer and humeral head replacement (HHR), using smaller humeral prostheses, in cuff tear arthropathy patients. The aim of the present study was to investigate the clinical outcome of our strategy in patients under 70 years of age who had irreparable rotator cuff tears and osteoarthritis. Materials and Methods: A total of 25 shoulders of 25 patients under 70 years of age (males, 15; females, 10) with irreparable cuff tears were treated with HHR and cuff reconstruction. The average age at the time of surgery was 64.3 years (range, 55 - 69) and the average follow-up period was 38.7 months (range, 24 - 72). The cuff defect was repaired using a partial subscapularis transfer in 14 shoulders; nine shoulders required a latissimus dorsi transfer, one required a pectoralis major transfer, and one required both a latissimus dorsi and a pectoralis major transfer. Clinical outcomes were assessed with the range of motion (ROM), UCLA score, Japanese Orthopaedic Association (JOA) score and postsurgical complications. Results: Shoulder pain was diminished in all patients after surgery. The preoperative UCLA and JOA scores were 13.1 and 47.0 respectively, improving to 28.6 and 81.5 respectively after surgery. Active forward flexion has improved from an average of 89.0° to 138.8°, and the ER improved from an average of 16.2° to 33.2°. No complications occurred after surgery. Conclusion: Anatomical reconstruction using smaller head humeral prostheses yielded favorable results and less complication, compared with RSA. Considering another advantage of ability to retain glenoid bone stock, the current procedure can be a useful option for irreparable rotator cuff tears with OA in patients under 70 years old.

Keywords

Irreparable Rotator Cuff Tear, Cuff Reconstruction, Cuff Tear Arthropathy, Humeral Head Replacement Using a Small Head

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Boileau, P., Watkinson, D., Hatzidakis, A.M. and Hovorka, I. (2006) The Grammont Reverse Shoulder Prosthesis: Results in Cuff Tear Arthritis, Fracture Sequelae, and Revision Arthroplasty. Journal of Shoulder and Elbow Surgery, 15, 527-540. http://dx.doi.org/10.1016/j.jse.2006.01.003
[2]	Favard, L., Levigne, C., Nerot, C., Gerver, C., Wilde, L.D. and Mole, D. (2011) Reverse Prostheses in Arthropathies with Cuff Tear: Are Survivorship and Function Maintained Over Time? Clinical Orthopaedics and Related Research, 469, 2469-2475. http://dx.doi.org/10.1007/s11999-011-1833-y
[3]	Guery, J., Favard, L., Sirveaux, F., Oudet, D., Mole, D. and Walch, G. (2006) Reverse Total Arthroplasty: Survivorship Analysis of Eighty Replacements Followed for Five to Ten Years. The Journal of Bone and Joint Surgery, 88, 1742-1747. http://dx.doi.org/10.2106/JBJS.E.00851
[4]	Sirveaux, F., Favard, L., Oudet, D., Huquet, D., Walch, G. and Mole, D. (2004) Grammont Inverted Total Shoulder Arthroplasty in the Treatment of Glenohumeral Osteoarthritis with Massive Rupture of the Cuff: Results of a Multicenter Study of 80 Shoulders. The Journal of Bone and Joint Surgery, 86, 388-395. http://dx.doi.org/10.1302/0301-620X.86B3.14024
[5]	Wall, B., Nove-Josserand, L., O’Connor, D.P., Edwards, T.B. and Walch, G. (2007) Reverse Total Shoulder Arthroplasty: A Review of Results According to Etiology. The Journal of Bone and Joint Surgery, 89, 1476-1485. http://dx.doi.org/10.2106/JBJS.F.00666
[6]	Werner, C.M.L., Steinmann, P.A., Gilbart, M. and Gerver, C. (2005) Treatment of Painful Pseudoparesis Due to Irreparable Rotator Cuff Dysfunction with the Delta III Reverse-Ball-and-Socket Total Shoulder Prosthesis. The Journal of Bone and Joint Surgery, 87, 1476-1486.
[7]	Yamane, S., Suenaga, N., Oizumi, N. and Funakoshi, T. (2011) Total Shoulder Arthroplasty and Humeral Head Replacement for Osteoarthritis and Cuff Tear Arthropathy in Patients 75 Years Old and Older. Katakansetsu, 35, 641-644.
[8]	Neer, C.S. 2nd, Craig, E.V. and Fukuda, H. (1983) Cuff Tear Arthropathy. The Journal of Bone and Joint Surgery, 65, 1232-1244.
[9]	Arntz, C.T., Jackins, S. and Matsen, F.A. 3rd. (1993) Prosthetic Replacement of the Shoulder for the Treatment of Defects in the Rotator Cuff and the Surface of the Glenoid Joint. The Journal of Bone and Joint Surgery, 75, 485-491.
[10]	Field, L.D., Dines, D.M., Zabinski, S.F. and Warren, R.F. (1997). Hemiarthroplasty of the Shoulder for Rotator Cuff Arthropathy. Journal of Shoulder and Elbow Surgery, 6, 18-23. http://dx.doi.org/10.1016/S1058-2746(97)90066-5
[11]	Goldberg, S.S., Bell, J.E., Kim, H.J., Bak, S.F., Levine, W.N. and Bigliani, L.U. (2008) Hemiarthroplasty for the Rotator Cuff-Deficient Shoulder. The Journal of Bone and Joint Surgery, 90, 554-559. http://dx.doi.org/10.2106/JBJS.F.01029
[12]	Goldberg, S.S. and Bigliani, L.U. (2009) Hemiarthroplasty for the Rotator Cuff-Deficient Shoulder Surgical Technique. The Journal of Bone and Joint Surgery, 91, 22-29.
[13]	Pollock, R.G., Deliz, E.D., Mcllveen, S.J., Flatow, E.L. and Bigliani, L.U. (1992) Prosthetic Replacement in Rotator Cuff Deficient Shoulders. Journal of Shoulder and Elbow Surgery, 1, 173-186. http://dx.doi.org/10.1016/1058-2746(92)90011-Q
[14]	Sanchez-Sotelo, J., Cofield, R.H. and Rowland, C.M. (2001) Shoulder Hemiarthroplasty for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency. The Journal of Bone and Joint Surgery, 83-A, 1814-1822.
[15]	Duralde, X.A. and Bair, B. (2005) Massive Rotator Cuff Tears: The Result of Partial Rotator Cuff Repair. Journal of Shoulder and Elbow Surgery, 14, 121-127. http://dx.doi.org/10.1016/j.jse.2004.06.015
[16]	Ha’eri, G.B. and Wiley, A.M. (1981) Advancement of the Supraspinatus Muscle in the Repair of Ruptures of the Rotator Cuff. The Journal of Bone and Joint Surgery, 63, 232-238.
[17]	Labbe, M.R. (2006) Arthroscopic Technique for Patch Augmentation of Rotator Cuff Repairs. Arthroscopy, 22, 1136.e1-1136.e6.
[18]	Aoki, M., Okamura, K., Fukushima, S., Takahashi, T. and Ogino, T. (1996) Transfer of Latissimus Dorsi for Irreparable Rotator-Cuff Tears. The Journal of Bone and Joint Surgery, 78-B, 761-766.
[19]	Gerber, C. (1992) Latissimus Dorsi Transfer for the Treatment of Irreparable Tears of the Rotator Cuff. Clinical Orthopaedics and Related Research, 275, 152-160