Name: Reverse Total Shoulder Arthroplasty After Multiple Failed RCRs
Uploaded: 2018-05-02T00:00:00Z
Channel: Arthrex

Arthroplasty Shoulder

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VPT1-00637-EN | A | Reverse Total Shoulder Arthroplasty After Multiple Failed RCRs

Anthony A. Romeo

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Reverse Total Shoulder Arthroplasty After Multiple Failed RCRs

I'm going to talk to you about a really challenging problem that many of us see. As you know, more than 350,000 rotator cuff repairs are performed in the United States every year, and somewhere around 20% or more. That tendon fails to heal down to the bone, and the patients don't get the results that they like. And these cases of multiple failed rotator cuff repairs really are challenging to try to get a good result. And so I'll present to you this patient who came to my office. She's a 60 year old female. She has right shoulder pain. She's had two prior rotator cuff repairs, both of which failed to get the tendon to heal down to bone. She's having increasing pain in her shoulder despite appropriate rehabilitation. She's had cortisone injections. She has been able to maintain a range of motion nicely at 160 degrees of elevation, external rotation 50 degrees, but her strength is limited because of the superior posterior aspect of her rotator cuff not doing very well. These are a pre-operative radiographs, and what we notice is not only does she have a problem with her rotator cuff now, but she's also having some increasing osteoarthritic changes and their early signs include that inferior osteophyte on the humeral side, as well as some changes in the normal circular pattern of the humeral head. If we look at this more carefully on an MRI, which will give us really good information about the soft tissues, please pay attention to the amount of retraction of the supraspinatus, but also look on that right side. The infraspinatus is greater than 50% atrophy. The teres minor is involved. Her supraspinatus has some muscle left and you see the normal looking subscapularis. So two prior failed rotator cuff surgeries. And she has significant muscle atrophy which we know in many cases is irreversible. What are we going to do. Well, the most reliable operation in this patient is going to be a reverse total shoulder arthroplasty. This operation gives us the opportunity to do a number of things. Number one, with the Arthrex reverse it's a press fit stem. Number two, we can create a more anatomic position even with the reverse, where we put it at 135 degrees of inclination and a lateral offset, which tensions the deltoid in a good position to help with their internal and external rotation, while still allowing that forward elevation. And as you see with the range of motion, she's up to 145 ActivLoc or external rotation is good and her strength is also played out very well. But most importantly, she's relatively pain free and is able to move on with many of her activities. Not everyone gets this kind of result. Some patients with multiple surgeries will have persistent pain, and the range of motion won't be as good as we would like to see. But this is an excellent operation to try to solve. That case of the patient who has had multiple rotator cuff repairs and sort of feels like there's nothing else you can do. This is an operation that will help alleviate their pain and return their function for activities of daily living, and get them back to their normal life. Here's an axillary lateral view. Here is the scapular y view. You can see how we can line this up perfectly with the scapular. And these are the kind of cases that we expect to get. A minimum of 90% or more of these patients will have this for ten years. But the recent information from Europe tells us even out to 15 years, we're looking somewhere around 85 to 95% retention rate. And that's really an excellent result for the 60 year old lady, who has already failed two prior rotator cuff repair surgeries.

Reverse Total Shoulder Arthroplasty After Multiple Failed RCRs

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