Clinical effectiveness and safety of the extended humeral head arthroplasty for selected patients with rotator cuff tear arthropathy.
BACKGROUND
Cuff tear arthropathy is commonly managed with a reverse total shoulder arthroplasty (RTSA). A humeral hemiarthroplasty with an extended humeral head may provide a less invasive alternative for selected patients with cuff tear arthropathy if the shoulder has preserved active elevation. Because evidence regarding this procedure is limited, we investigated its safety and efficacy in treating selected patients with cuff tear arthropathy.


METHODS
We analyzed the preoperative characteristics, surgical findings, and clinical outcomes for patients selected for extended head hemiarthroplasty.


RESULTS
For 42 patients with 2-year follow-up, there were no complications or revisions. The Simple Shoulder Test score improved from a median of 3.0 to 8.0 (P < .001). The median percentage of maximal possible improvement was 50% (P < .001). The percentage of patients able to perform each of the functions of the Simple Shoulder Test was significantly improved; for example, the ability to sleep comfortably increased from 19% to 71%, and the ability to place a coin on the shelf at shoulder level increased from 38% to 86% (P < .001).


CONCLUSIONS
There are circumstances in which RTSA is clearly the preferred procedure for cuff tear arthropathy, including pseudoparalysis, anterosuperior escape, and glenohumeral instability; however, in shoulders with preserved active motion and stability of the humeral head provided by an intact coracoacromial arch, the extended head humeral arthroplasty can enable selected patients to realize improved comfort and function without the potential risks of RTSA. Extended humeral head hemiarthroplasty can provide a safe and effective alternative for the management of selected patients with rotator cuff tear arthropathy and preserved active motion.
['Matsen|Frederick A|FA|', 'Somerson|Jeremy S|JS|', 'Hsu|Jason E|JE|', 'Lippitt|Steven B|SB|', 'Russ|Stacy M|SM|', 'Neradilek|Moni B|MB|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D005260:Female D005500:Follow-Up Studies D062785:Hemiarthroplasty D006801:Humans D058430:Humeral Head D008297:Male D008875:Middle Aged D018579:Patient Selection D000070636:Rotator Cuff Injuries D000070656:Rotator Cuff Tear Arthropathy D012785:Shoulder Joint D016896:Treatment Outcome
extended humeral head rotator cuff tear arthropathy hemiarthroplasty clinical outcomes patient selection CTA prosthesis