Jensen, J Bone Joint Surg Am 1999 - Current Concepts Review - Rotator Cuff Tear Arthropathy

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Current Concepts Review - Rotator Cuff Tear Arthropathy

Jensen, Rockwood, et al.·J Bone Joint Surg Am·1999·113 citations·Review article

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This current concepts review synthesizes the many historical names and theories for rotator cuff tear arthropathy into one clinical syndrome. It examines the etiology, biomechanics, diagnosis, and treatment of end-stage cuff-deficient glenohumeral arthritis. The review clarifies why glenoid resurfacing fails and how hemiarthroplasty and rehabilitation goals should be structured.

Key Findings

The condition overwhelmingly affects elderly women. Across 104 pooled patients, 90 were female with an average age of 77.5 years, and nearly half had bilateral disease. Expect this demographic on the exam.
Only about 4% of complete cuff tears progress to arthropathy. Most tears are too small to destabilize the joint, so cuff tear arthropathy is the exception, not the rule.
The rocking-horse glenoid explains why total shoulder replacement fails here. Glenoid loosening occurred in 7 of 14 cuff-deficient shoulders versus 0 of 16 with an intact cuff at 2.5 years. This is the single most important surgical decision point.
Hemiarthroplasty reliably relieves pain but gives inconsistent motion. Across three series pain scores dropped to about 0.6 to 0.8 out of 3, while forward elevation reached only 100 to 120 degrees.
An intact coracoacromial arch is essential. In one series all 4 patients with prior acromioplasty and coracoacromial release failed, versus 10 of 12 successes when the arch was preserved. Do not violate the arch.
Débridement without arthroplasty can be durable in cuff-deficient shoulders without arthritis. None of 53 shoulders deteriorated and 83% were satisfactory after acromioplasty and débridement.
Constrained prostheses fail mechanically. Glenoid loosening occurred in 10 of 49 Stanmore implants and major complications in 29 of 94 Michael Reese prostheses.

Board PearlIn cuff tear arthropathy, hemiarthroplasty is preferred over total shoulder replacement because a cuff-deficient glenoid loosens via the rocking-horse mechanism.

Current Concepts Review - Rotator Cuff Tear Arthropathy

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|

Current Concepts Review - Rotator Cuff Tear Arthropathy

Jensen, Rockwood, et al.·J Bone Joint Surg Am·1999·113 citations·Review article

|

This current concepts review synthesizes the many historical names and theories for rotator cuff tear arthropathy into one clinical syndrome. It examines the etiology, biomechanics, diagnosis, and treatment of end-stage cuff-deficient glenohumeral arthritis. The review clarifies why glenoid resurfacing fails and how hemiarthroplasty and rehabilitation goals should be structured.

Key Findings

The condition overwhelmingly affects elderly women. Across 104 pooled patients, 90 were female with an average age of 77.5 years, and nearly half had bilateral disease. Expect this demographic on the exam.
Only about 4% of complete cuff tears progress to arthropathy. Most tears are too small to destabilize the joint, so cuff tear arthropathy is the exception, not the rule.
The rocking-horse glenoid explains why total shoulder replacement fails here. Glenoid loosening occurred in 7 of 14 cuff-deficient shoulders versus 0 of 16 with an intact cuff at 2.5 years. This is the single most important surgical decision point.
Hemiarthroplasty reliably relieves pain but gives inconsistent motion. Across three series pain scores dropped to about 0.6 to 0.8 out of 3, while forward elevation reached only 100 to 120 degrees.
An intact coracoacromial arch is essential. In one series all 4 patients with prior acromioplasty and coracoacromial release failed, versus 10 of 12 successes when the arch was preserved. Do not violate the arch.
Débridement without arthroplasty can be durable in cuff-deficient shoulders without arthritis. None of 53 shoulders deteriorated and 83% were satisfactory after acromioplasty and débridement.
Constrained prostheses fail mechanically. Glenoid loosening occurred in 10 of 49 Stanmore implants and major complications in 29 of 94 Michael Reese prostheses.

Board PearlIn cuff tear arthropathy, hemiarthroplasty is preferred over total shoulder replacement because a cuff-deficient glenoid loosens via the rocking-horse mechanism.

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