Cuff-tear debridement not effective for RA patients

Only patients with partial thickness rotator cuff tears reported significant long-term satisfaction with the treated shoulder.

VANCOUVER, British Columbia — Debridement of rotator cuff tears does not provide adequate long-term pain relief in patients with rheumatoid arthritis, according to a study presented here.

“This procedure does not halt the progression of arthritis. And while pain relief can occur, results for pain relief and satisfaction were much less favorable for full-thickness tear patients,” said Adam M. Smith, MD, an orthopedic surgeon at University Orthopedics in Chattanooga, Tenn. Night pain and range of motion also had not improved, he noted.

Smith conducted the study with colleagues at the Mayo Clinic in Rochester, Minn. He presented the results at the Arthroscopy Association of North America 24th Annual Meeting.

“We conclude that surgeon and patient expectations for the use of this procedure over the long-term should be considered limited,” he said.

Mayo Clinic data

Smith and colleagues reviewed Mayo Clinic data for rheumatoid arthritis patients treated for rotator cuff tears between 1988 and 2002. The decision to undergo treatment was based strictly on patient and surgeon preference, Smith said.

The study included 17 shoulders among 16 patients with a mean age of 65 years. Seven shoulders had partial-thickness tears and 10 shoulders had full-thickness tears — five large and five massive tears.

Sixteen shoulders underwent arthroscopic surgery and one shoulder required a mini-open approach. In all cases, surgeons performed glenohumeral debridement and debridement of any synovial inflammation to excise all pathologic cuff tissue. Surgeons also performed synovectomy in all cases, acromioplasty in six, biceps debridement in three and tenodesis in one, Smith said.

Surgeons followed patients for a mean 6.7 years postop. In addition to clinical outcome measures, all patients completed a questionnaire that assessed subjective pain and function.

Nonsignificant long-term improvement

Pain had improved in six of the seven patients with partial tears (P=.03) and in five of the 10 patients with full-thickness tears (P=.06). However, most patients continued to report pain at night and presence of at least mild-to-moderate pain most of the time, Smith said.

Postoperative range of motion did not improve significantly for patients with either full- or partial-thickness tears, he noted.

Only patients with partial-thickness tears reported significant long-term satisfaction with their shoulder (P=.02) , which was subjectively rated using a scale from one to 10, Smith said.

“Similar results were seen for functional outcomes with the ASES and SST scores,” he said. “In addition, all seven patients with partial-thickness tears had at least satisfactory results ... while eight of 10 patients with full-thickness tears had unsatisfactory results,” he added.

Postoperative complications included one patient with an initial massive tear who required a hemiarthroplasty due to pain and dysfunction at four years postop. Surgeons also offered hemiarthroplasty to two other patients who experienced waning pain relief despite good initial results — at three years postop in one patient who had an initial large tear and at five years postop due to advancing arthritis in one patient who had an initial partial tear.

For more information:
Smith AM, Sperling JW, Cofield RH. Results of rotator cuff debridement in patients with rheumatoid arthritis. #52. Presented at the Arthroscopy Association of North America 24th Annual Meeting. May 12-15, 2005. Vancouver, British Columbia.