| A
HEMIARTHROPLASTY FOR ROTATOR CUFF DEFICIENT SHOULDERS* |
BY Fred
M. Carter II MD, Andrew P. Bush MD, Frederick F. Buechel MD,
Michael J Pappas PhD
ABSTRACT
The disruption
of the rotator cuff and or its associated musculature by severe
degenerative change, rheumatoid changes or prior surgical
intervention disrupts action of the adductors resulting in
an inability to balance abductor forces. Therefore restoration
of shoulder force balance is necessary in shoulder joint using
current, unconstrained shoulder prostheses. If restoration
of lost cuff function cannot be achieved, current shoulder
designs cannot prevent impingement of the prosthesis or humerus
with the acromion, and therefore do not provide a satisfactory
replacement. The Buechel-Pappas salvage shoulder prosthesis
is designed to provide joint replacement in the unreconstructable,
unstable, adductor deficient shoulder.
Nine patients
with severe rotator cuff disease secondary to either rheumatoid
arthritis, severe degenerative changes, or failed primary
arthroplasty, were selected for implantation of the bipolar
shoulder hemiarthoplasty. The patients were followed for an
average of thirty-four months (range 12-57 months).
In the
salvage situation, pain relief is the primary goal while function
and stability is the next priority. In eight of the nine patients
pain markedly improved while all reported being able to resume
ASDL’s with the involved shoulder. Forward flexion improved
from an average of 41 degrees (15-80) to an average of 81
degrees (45-120). Abduction increased from 30 degrees (20-45)
to 69 degrees. Average external and internal rotation also
doubled from preoperative values of 24 degrees (0-90) and
25 degrees (0-60) to 59 degrees (40-90) and 57 degrees (30-90)
respectively.
The early
results of this prosthesis are promising. Longer follow-up
and greater numbers will be needed to confirm the role of
the prothesis as a salvage device for the rotator cuff deficient
shoulder
|
