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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 6/2010

01-06-2010 | Symposium: Current Concepts in Rotator Cuff Disease and Treatment

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Authors: Gregory N. Drake, DO, Daniel P. O’Connor, PhD, T. Bradley Edwards, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2010

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Abstract

Background

Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA’s approval in 2004, the appropriateness in patients with rotator cuff disease is unclear.

Questions/purposes

We review the use of RTSA in patients with rotator cuff disease to (1) describe classification of rotator cuff tear reparability and the concept of a balanced shoulder; (2) explore the theory behind RTSA design relative to rotator cuff arthropathy; (3) discuss the indications and contraindications for RTSA; and (4) review published outcomes of RTSA for rotator cuff arthropathy.

Methods

We performed a selective review of the literature on the use of RTSA in the treatment of rotator cuff disease.

Results

Modern RTSA designs restore deltoid tension and a functional fulcrum to the rotator cuff deficient shoulder, which allows recovery of active shoulder elevation and effectively restores function in short- and medium-term followup studies.

Conclusions

In short-term followup the RTSA relieves symptoms and restores function for patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis (preserved deltoid contraction but loss of active elevation). Severely impaired deltoid function, an isolated supraspinatus tear, and the presence of full active shoulder elevation with a massive rotator cuff tear and arthritis are contraindications to RTSA.

Clinical Relevance

For properly selected patients who have symptomatic and disabling rotator cuff deficiency, RTSA can result in life-changing improvements in pain, motion, function, and patient satisfaction.

Level of Evidence

Level V therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Metadata
Title
Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease
Authors
Gregory N. Drake, DO
Daniel P. O’Connor, PhD
T. Bradley Edwards, MD
Publication date
01-06-2010
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 6/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-009-1188-9

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