Clinical practice and progression of reverse total shoulder arthroplasty treatment for irreparable rotator cuff tear
10.3760/cma.j.cn121113-20230921-00189
- VernacularTitle:反式全肩关节置换治疗不可修复性肩袖撕裂的临床应用及研究进展
- Author:
Xuchao ZHANG
1
;
Weidong XU
Author Information
1. 海军军医大学第一附属医院（上海长海医院）关节骨病外科，上海 200433
- Keywords:
Rotator cuff injuries;
Arthroplasty, replacement, shoulder;
Medialization of center of rotation
- From:
Chinese Journal of Orthopaedics
2024;44(14):987-994
- CountryChina
- Language:Chinese
-
Abstract:
Irreparable rotator cuff tear (IRCT) is highly prevalent among the middle-aged and elderly populations, significantly affecting patients' daily lives and functional capabilities. These tears often result from chronic wear and tear, degenerative changes, or acute trauma. Tendon degeneration and scarring make conventional repair surgeries, such as arthroscopic rotator cuff repair, tendon transfer procedures, subacromial bursectomy, and superior capsule reconstruction, yield inconsistent clinical outcomes. Reverse total shoulder arthroplasty (RTSA) reverses the anatomical structure of the glenohumeral joint, medially displaces the humeral head's center of rotation, and distally extends the humeral shaft. This configuration increases the deltoid moment arm during abduction, enhancing glenohumeral joint stability and range of motion. For patients with shoulder joint dysfunction caused by a disrupted force couple balance, this surgical approach can effectively harness the deltoid muscle's power, significantly improving shoulder joint function in the presence of massive rotator cuff defects. The center of rotation of the glenoid prosthesis and the inclination angle of the humeral prosthesis are key factors affecting the prosthesis's stability. RTSA serves not only as a primary treatment option for elderly patients with IRCT but also as a salvage measure after the failure of other treatment plans, demonstrating satisfactory outcomes in the mid to long term. The success rate of surgery and patient satisfaction are influenced by multiple factors. Postoperatively, it is crucial to focus on phased rehabilitation goals and methods following RTSA to ensure that patients can engage in daily activities without exerting undue stress or causing injury to the prosthetic joint. Additionally, potential complications after RTSA, such as glenoid notching, shoulder instability, periprosthetic fractures, and prosthetic joint infection, must be prevented through meticulous preoperative planning, intraoperative techniques, and postoperative management. Should these complications arise, they require timely identification and appropriate treatment. Finally, the contentious issues regarding the use of RTSA in treating IRCT-such as the combination of tendon transfer to improve external rotation, repair of the subscapularis to enhance internal rotation strength, and the indications for surgical age-necessitate further clinical research and long-term follow-up for resolution. These conclusions provide evidence-based guidance for treating patients with IRCT, clarify the advantages and considerations of RTSA in treating IRCT, and aim to offer new perspectives for optimizing treatment plans, improving patient quality of life, and promoting medical research.
