Clinical Orthopaedics and Related Research®
Volume 468, Number 6, 1526-1533, DOI: 10.1007/s11999-009-1188-9

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The Association of Bone and Joint Surgeons®

Symposium: Current Concepts in Rotator Cuff Disease and Treatment

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Gregory N. Drake, Daniel P. O’Connor and T. Bradley Edwards

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Abstract

Background  

Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA’s approval in 2004, the appropriateness in patients with rotator cuff disease is unclear.

Questions/purposes  

We review the use of RTSA in patients with rotator cuff disease to (1) describe classification of rotator cuff tear reparability and the concept of a balanced shoulder; (2) explore the theory behind RTSA design relative to rotator cuff arthropathy; (3) discuss the indications and contraindications for RTSA; and (4) review published outcomes of RTSA for rotator cuff arthropathy.

Methods  

We performed a selective review of the literature on the use of RTSA in the treatment of rotator cuff disease.

Results  

Modern RTSA designs restore deltoid tension and a functional fulcrum to the rotator cuff deficient shoulder, which allows recovery of active shoulder elevation and effectively restores function in short- and medium-term followup studies.

Conclusions  

In short-term followup the RTSA relieves symptoms and restores function for patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis (preserved deltoid contraction but loss of active elevation). Severely impaired deltoid function, an isolated supraspinatus tear, and the presence of full active shoulder elevation with a massive rotator cuff tear and arthritis are contraindications to RTSA.

Clinical Relevance  

For properly selected patients who have symptomatic and disabling rotator cuff deficiency, RTSA can result in life-changing improvements in pain, motion, function, and patient satisfaction.

Level of Evidence  

Level V therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution either has waived or does not require approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at Fondren Orthopedic Group, Houston, Texas.

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