Cuff Tear Arthropathy

Reverse prosthesis designs were developed for use in cases of rotator cuff tear arthropathy, and although they continue to be used primarily in such cases, they have also been used in others. From a series of 240 reverse prosthesis cases. Wall and colleagues [39] report that 31% were used for rotator cuff tear arthropathy, 22.5% for revision arthroplasty, 17% for massive rotator cuff tears, 14% for primary OA, and 14% for posttraumatic arthritis. In marked contrast to other TSA studies, only 1 of the 240 cases reported by Wall and coworkers was done for RA [39]. 

The reverse shoulder concept was first developed and implanted in Europe by Professor Paul Grammont in 1985 to allow treatment of patients with rotator cuff tear arthropathy [50]. Initial versions included a relatively constrained articulation between the ball and socket and were largely unsuccessful because of loosening [51]. In 1987, Grammont and Baulot designed a semiconstrained reverse prosthesis and recommended it be used prudently and in patients older than 70 years of age [51]. After years of use in Europe, the first reverse prosthesis case was done in North America in February 2003 [52]. In November 2003, the FDA first cleared a reverse prosthesis design for sale in the United States, and the first United States case was done in March 2004 [38]. 

Taking a closer look at these results shows differences with respect to a number of variables. The indications for TSA are varied and therefore present unique challenges to the repair. In general, standard TSA performed to address problems caused by primary arthritis (OA or RA) are the most successful [18, 20, 22, 24, 26, 29, 74], and the success rates for standard TSA performed to address problems due to fracture are substantially lower [1, 5]. In younger patients (less than 50 years old), the results for TSA are also generally less successful than those performed in older patients [1, 6, 21]. Similarly, results for reverse TSA are better when it is used in cases of rotator cuff tear arthropathy than when it is used in cases of revision or posttraumatic arthritis [38, 39]. 

Diaz-Borjon E, et al. Shoulder replacement in end-stage rotator cuff tear arthropathy 5- to 11-year follow-up analysis of the bi-polar shoulder prosthesis. J Surg Orthop Adv 2007 16(3) 123-30. 

Among the degenerative arthropathies that typically involve the shoulder, there are a variety of conditions related to crystal deposition diseases, including renal osteodystrophy, milk alkali syndrome, hyper-vitaminosis D and the so-called Milwaukee shoulder syndrome . This last condition, which is also known as apatite-associated destructive arthritis, hemorrhagic shoulder or rapid destructive arthritis of the shoulder, consists of massive rotator cuff tear, osteoarthritic changes, hlood-stained noninflammatory joint effusion containing calcium hydroxyapatite and calcium pyrophosphate dihydrate crystals, synovial hyperplasia and extensive destruction... 

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