Which is the treatment for rotator cuff tear arthropathy?

The term cuff tear arthropathy refers to a primary massive rotator cuff tear that by virtue of mechanical superior instability and nutritional effects leads to a secondary glenohumer- al joint destniction. Treatment takes into account the patient\rdblquote s symptoms, function needs and the bone and soft tissue conditions of the shoulder joint. ln the common practice, entity of degenerative changes represents the watershed between conservative and destroying surgery. We assessed functional outcome (Constant\rquote s method) of patients with slight (CSA)(Type la-b Seebauer\rquote s classification) or severe cuff tear arthropathy who were differently surgically treated. Stable fulerum, competent coraco-acromial arch and osteophytes lesser than 3 mm were the radiographic requisites to consider arthropathy as slight. Thirty-five patients with CSA (Goutallierzl-2) who underwent open acromioplasty + tendinous suture(l2) transosseous tixation( 8), HA(l l) and TSA(4) were clinically assessed (mean EU: 3yrs). Analogously, a retrospective study was carried out, respectively, on ll and l0 cases of shoulder hemi- arthroplasty (group 1) and reverse prosthesis (group II), performed for severe cuff tear arthropathy. Post-operatively outcomes were graded according the "limited goals criteria" for patients with permanent rotator cuff deficiency. Pre-operative score of patients with CSA who underwent decompression + cuff sutureffixation, HA and TSA was, respectively, 36-32-30-28; whilst the postoperative was 62-58-52-38. Causes of score decrease were partial pain relief and improvement in strength in no prosthesized patients; and scarce increase in ROM and in strength in those who underwent replacement. Two patients with TSA had glenoid loosening. The mean Constant score increased, compared to the pre\emdash operatively score, by 22% in the group of patients with severe cuff arthropathy and with HA and 28% in group of patients with reverse prosthesis. In both groups, shoulder pain decreased or disappeared; however, in the group with reverse prosthesis, we observed a greater mean increase in the elevation and abduction of the shoulder. Both groups underwent little improvement of the external rotation whilst no increase of the shoulder strength was observed. Patients with CSA obtain generally satisfactory results after decompression +suture/fiie ation. However, over the time, cuff failure may cause a decrease in score. Patients must be informed regarding the possibility of a future replacement of the joint and those outcomes, after arthroplasty, are not so satisfactory than those obtained on shoulders not previously operated on. HA decrease pain, however does not increase considerably in ROM and strength. Patients with TSA had frequently unsatisfactory results for the "rocl<ing-horse" phenomenon. Furthermore, our study indicates that favourable outcomes can be obtained when an hemiarthroplasty or a reverse prosthesis are performed for severe cuff tear arthropathy, even if the results of hemiarthroplasty are worse compared with those obtained in patients with concentric arthropathy. Patients with reverse prosthesis undergo a greater increase in elevation and abduction, compared to those with an hemiarthroplasty.