Treatment of severe cuff tear arthropathy with the humeral head resurfacing arthroplasty: two-year minimum follow-up.

BACKGROUND

The aim of the study was to evaluate the outcome of a humeral head resurfacing arthroplasty implanted toward valgus for patients with cuff tear arthropathy (CTA).

MATERIALS AND METHODS

We monitored 24 patients with CTA who underwent resurfacing arthroplasty. Patients were assessed with use of the Constant score and a subjective satisfaction score. The rotator cuff was evaluated preoperatively by magnetic resonance imaging. The Sirveaux classification of glenoid erosion in glenohumeral osteoarthritis with massive rupture of the cuff was used to grade the preoperative status of the glenoid.

RESULTS

The mean absolute Constant score for the entire cohort improved from 21 points (range, 7-44 points) to 63 points (range, 23-89 points) at a mean of 38 months (range, 24-56 months). Patients with an intact or moderately atrophied teres minor muscle (n = 16) showed a significantly better Constant score (P = .011) and greater active external rotation (P = .034) than patients with severe atrophy. Neither the type of glenoid erosion according to Sirveaux nor the inclination angle of the implant has an effect on the clinical or functional outcome.

CONCLUSIONS

For selected patients with CTA, resurfacing arthroplasty of the humeral head provides satisfactory medium-term outcomes. The teres minor muscle is necessary for maintaining or establishing external rotation. In patients with massive limitation of motion and total absence of the subscapularis tendon, the implantation of a humeral surface replacement should be seriously considered.