Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years

Abstract

Background: The role of reverse shoulder arthroplasty (RTSA) in the relatively young individual is currently unclear. Our study evaluates the midterm to long-term results of RTSA for patients aged younger than 65 years with pseudoparalysis secondary to massive irreparable rotator cuff tears, with or without arthritis.

Methods: Between 1997 and 2006, 46 RTSAs (41 patients) were performed. Mean age was 60 years (range, 46-64 years). At the latest follow-up, 5 patients had died and 1 was lost, leaving 35 patients (40 shoulders) with a mean follow-up of 93 months (range, 60-171 months).

Results: The mean relative Constant score increased from 34% to 74% (P < .0001) and the subjective shoulder value improved from 23% to 66% (P < .0001). Significant improvements were seen in active forward elevation (72° to 119°), pain scores, and strength (P < .001). One or more complications occurred in 15 shoulders (37.5%), with 6 failures (15%) resulting in removal or conversion to hemiarthroplasty (3 with infection, 3 with glenoid loosening). Ten shoulders (25%) underwent partial or total component exchange, conversion to hemiarthroplasty, or removal. Of the 15 patients who developed complications, 9 did not require prosthesis removal or conversion and functional outcome and subjective shoulder value were similar to those with no complications (P > .4).

Conclusion: RTSA in younger patients provides significant subjective improvement and substantial gain in overall function, which is maintained up to 10 years. Although the complication rate is high, most can be treated successfully without compromise to clinical outcome. However, it is imperative that the high complication rate is explained to patients, with the risks and benefits carefully considered.

Keywords: Case Series; Level IV; Reverse shoulder arthroplasty; Treatment Study; cuff tear arthropathy; irreparable rotator cuff tear; pseudoparalysis.