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. 2013 Oct;7(4):127-31.
doi: 10.4103/0973-6042.123509.

The influence of rotator cuff pathology on functional outcome in total shoulder replacement

Nathanael Ahearn  1 , Philip A McCann  1 , Andrew Tasker  1 , Partha P Sarangi  1
Affiliations

The influence of rotator cuff pathology on functional outcome in total shoulder replacement

Nathanael Ahearn et al. Int J Shoulder Surg. 2013 Oct.

Abstract

Introduction: Total shoulder replacement (TSR) is a reliable treatment for glenohumeral osteoarthritis. In addition to proper component orientation, successful arthroplasty requires accurate restoration of soft tissues forces around the joint to maximize function. We hypothesized that pathological changes within the rotator cuff on preoperative magnetic resonance imaging (MRI) adversely affect the functional outcome following TSR.

Materials and methods: A retrospective analysis of case notes and MRI of patients undergoing TSR for primary glenohumeral osteoarthritis over a 4-year period was performed. Patients were divided into three groups based upon their preoperative MRI findings: (1) normal rotator cuff, (2) the presence of tendonopathy within the rotator cuff, or (3) the presence of a partial thickness rotator cuff tear. Intra-operatively tendonopathy was addressed with debridement and partial thickness tears with repair. Functional outcome was assessed with the Oxford Shoulder Score (OSS), and quick disabilities of the arm, shoulder and hand score (quick-DASH).

Results: We had a full dataset of complete case-notes, PACS images, and patient reported outcome measures available for 43 patients, 15 in group 1, 14 in group 2, and 14 in group 3. Quick-DASH and OSS were calculated at a minimum of 24 months following surgery. There was no statistically significant difference between the results obtained between the three groups of either the OSS (P = 0.45), or quick-DASH (P = 0.46).

Conclusions: TSR is an efficacious treatment option for patients with primary glenohumeral osteoarthritis in the medium term, even in the presence of rotator cuff tendonopathy or partial tearing. Minor changes within the cuff do not significantly affect functional outcome following TSR.

Keywords: MRI; outcome measures; rotator cuff; total shoulder replacement.

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Conflict of interest statement

Conflict of Interest: There are no conflicts of interest.

Figures

Figure 1
Figure 1
T2 weighted coronal MRI scan showing intact rotator cuff with muscle belly of normal signal and volume
Figure 2
Figure 2
T2 weighted coronal MRI scan showing abnormal increased signal in the distal supraspinatus tendon which appears to be thinned and compressed with no definite tear or tendon retraction seen
Figure 3
Figure 3
T2 weighted coronal MRI scan showing partial tearing of the supraspinatus tendon attachment. No full thickness tear or retraction is identified
Chart 1
Chart 1
Graph to show number of patients in each group, divided by preoperative MRI findings
Chart 2
Chart 2
Graph to show postoperative quick-DASH and Oxford Shoulder Score of each group, divided by preoperative MRI findings
See this image and copyright information in PMC

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