This case series looks at bipolar hemiarthroplasty for rotator cuff tear arthropathy. All 14 patients had failed conservative care, had no prior shoulder surgery, and an intact coracoacromial arch. The question: can a bipolar prosthesis give reliable pain relief and functional motion when the cuff is irreparable?
For an irreparable massive cuff tear with glenohumeral arthritis, the realistic surgical goal is pain relief and a stable fulcrum, not restored overhead motion. This series delivered 86% pain-free patients but left average flexion at 88°, so set expectations accordingly.
The single most important selection criterion is an intact coracoacromial arch. It is the superior restraint that keeps the humeral head from escaping anterosuperiorly once the cuff is gone. Do not resect the acromion or coracoacromial ligament in these patients.
Read this paper in its era. It predates the widespread adoption of reverse total shoulder arthroplasty, which now handles cuff tear arthropathy with better and more reproducible motion by medializing the center of rotation and recruiting the deltoid.
The durable lesson is diagnostic and biomechanical: superior migration of the humeral head signals loss of the cuff depressor mechanism, and any reconstruction must restore a stable fulcrum.
This case series looks at bipolar hemiarthroplasty for rotator cuff tear arthropathy. All 14 patients had failed conservative care, had no prior shoulder surgery, and an intact coracoacromial arch. The question: can a bipolar prosthesis give reliable pain relief and functional motion when the cuff is irreparable?
For an irreparable massive cuff tear with glenohumeral arthritis, the realistic surgical goal is pain relief and a stable fulcrum, not restored overhead motion. This series delivered 86% pain-free patients but left average flexion at 88°, so set expectations accordingly.
The single most important selection criterion is an intact coracoacromial arch. It is the superior restraint that keeps the humeral head from escaping anterosuperiorly once the cuff is gone. Do not resect the acromion or coracoacromial ligament in these patients.
Read this paper in its era. It predates the widespread adoption of reverse total shoulder arthroplasty, which now handles cuff tear arthropathy with better and more reproducible motion by medializing the center of rotation and recruiting the deltoid.
The durable lesson is diagnostic and biomechanical: superior migration of the humeral head signals loss of the cuff depressor mechanism, and any reconstruction must restore a stable fulcrum.