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Extended humeral head hemiarthroplasty may be safe, effective for rotator cuff tears
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Patients with rotator cuff tear arthropathy, preserved active motion and a stabilizing coracoacromial arch may experience safe and effective treatment with extended humeral head hemiarthroplasty, which researchers of a published study described as a less invasive alternative to reverse total shoulder arthroplasty.
Researchers analyzed preoperative characteristics, surgical findings and clinical outcomes of 42 patients who had symptomatic rotator cuff tear arthropathy and retained active elevation greater than 90° and underwent extended humeral head hemiarthroplasty and had no complications or revisions at 2-year follow-up. Results showed improvement in simple shoulder test scores from a median of 3 to 8, as well as improvement in the percentage of patients able to perform each of the functions of the simple shoulder test. Researchers noted an increase in the ability to sleep comfortably from 19% to 71% and in the ability to place a coin on a shelf at shoulder level from 38% to 86%. Researchers found a median percentage of maximal possible improvement of 50%.
Lower final simple shoulder test scores and lower percentage of maximal possible improvements were found among patients who reported having depression compared with patients without depression, according to results. Researchers also found a negative correlation between preoperative simple shoulder test score and the percentage of maximal possible improvement.
According to the researchers, reverse total shoulder arthroplasty is considered the principal alternative procedure for the surgical management of cuff tear arthropathy, specifically in patients with pseudoparalysis, anterosuperior escape, failed arthroplasty, complex fractures, coracoacromial arch deficiency, anteroposterior glenohumeral instability and deltoid deficiency.
“However, in shoulders with preserved active motion and stability of the humeral head provided by an intact coracoacromial arch, the less invasive extended head humeral arthroplasty may provide selected patients with the opportunity for improve comfort and function without the risk of complications potentially associated with [reverse total shoulder arthroplasty] RTSA,” the authors wrote. – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
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