Reverse total shoulder arthroplasty for irreparable rotator cuff tears without arthritis: A systematic review

Abstract

Introduction: Indications for reverse total shoulder arthroplasty (RTSA) have expanded over recent years. Whilst cuff tear arthropathy is an accepted indication, the results of its use in those without arthritis is not clear. The aim of this article is to review the literature on RTSA for massive rotator cuff tears without associated arthritis. Methods: A systematic review search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to find all studies with clinical outcomes on RTSA performed for massive irreparable rotator cuff tears (MIRCT) without arthritis. Results: Of the 160 studies produced by the search, a detailed analysis found 11 articles to be included in this review. There was variability in the implant style used and the outcome measures utilised, but all studies found improvement in the outcome following RTSA. Many studies advised judicious use following high complication rates, and caution was advised in those patients with pre-operatively preserved active forward elevation. Conclusion:The available evidence suggests that RTSA is a reliable option in older patients with persistent pain and lack of function following MIRCT even without arthritis. However, as outcomes are not significantly worse following failed rotator cuff repair, joint preserving options in the younger age group should be carefully considered in light of the relatively high complication rate associated with RTSA.

Superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement or balloon spacers for large and massive irreparable rotator cuff tears: a systematic review and meta-analysis

“…Ernstbrunner et al reported that improvement in shoulder scores may be sustained over 10 years in the presence of massive tears; however, survivorship was 85% at 5 years and 70% at 15 years [ 97 ]. Other series demonstrate a sustained improvement in shoulder scores and a lower incidence of complications in the absence of glenohumeral osteoarthritis; however, these remain a concern [ 98 , 99 ]. The National Joint Registry of England, Wales and Northern Ireland report a risk of revision of 3.85% at 8 years in all patients who receive a RSA, with a median patient age of 76 years [ 100 ].…”

The changing landscape of rotator cuff surgery

“…Although it was designed and advocated for use in Cuff Tear Arthropathy, the reliability of outcomes from this technique has seen its indications extend to patients with rotator cuff tears, with no arthritis. 15 Some of the risks associated with RSA are significant, and hence this will remain a reliable option for the elderly or those who have exhausted all the other options.…”

Multiple surgical treatment comparisons for irreparable rotator cuff tears: A network meta-analysis

“…In addition, there is a 10% to 33% repair rate for the life of such implants, and complications increase with each repair. [10,11] Therefore, it is difficult for surgeons are working hard to develop new surgical methods to treat IRCTs.…”

“…A recently popular approach to IRCTs is reverse total shoulder arthroplasty (RTSA), where RTSA allows the deltoid to replace the muscle of IRCTs and has shown good results in multiple trials. [10] This technique has been used in patients with significant glenohumeral arthritis, anterior superior escape, and/or pseudoparalysis. However, although complications after RTSA have improved, 20% to 50% of complications have been reported in a recent study.…”