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Should Arthroplasty for Management of Massive RTC Tear


- See:
       - massive rotator cuff tear - disscussion
       - shoulder hemiarthroplasty

- Discussion:
    - by definition, a massive RTC tear invovles tears of more than 5 cm and involves more than than one tendon;
          - further, massive tears cannot be repaired w/o excessive tension after lysis cuff adhesions and release of the coracohumeral ligament; (see cuff mobilization)

- Hemiarthroplasty in the Rototar Cuff Deficient Patient:
    - shoulder hemiarthroplasty:
          - in cases of massive rotator cuff tears, glenohumeral arthritis may develop (cuff tear arthropathy) but the exact incidence is hard to determine;
          - requires a functionally intact coracoacromial arch to provide superior secondary stability for the prosthesis;
          - one important consideration requires a selection of a sufficiently small prosthesis so that excessive tightness of the posterior aspect of the capsule could be avoided;
          - in the report by Sanchez-Sotelo J, et al (2001), the authors evaluated the effects of hemiarthroplasty on massive rotator cuff tear;
                 - the authors noted that 27% patients had persistent pain at rest;
                 - anterosuperior instability occured in 7/33 shoulders, and was more common with prior acromioplasty;
                 - the authors concluded that the procedure was acceptable for patients with severe rest pain;
          - technical pearls:
                 - humeral head size should allow 50% inferior and posterior translation;
                 - good results may be partially dependent on having an intact acromion and CA ligament (for containment of the humeral head);
                 - oversizing of the humeral head may end up translating the humeral head anteriorly, disrupting soft tissue tension;
                 - gains in active forward elevation are inconsistent
                 - Shoulder hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency.

Replacement arthroplasty of the rotator cuff deficient shoulder.

Prosthetic replacement of the shoulder for the treatment of defects in the rotator cuff and the surface of the glenohumeral joint.

Hemiarthroplasty in rotator cuff-deficient shoulders.                 

Prosthetic replacement in rotator cuff deficient shoulders.  

Surgical management of complex irreparable rotator cuff deficiency.