Review Question - QID 218179

Patients with primary glenohumeral osteoarthritis and concomitant partial rotator cuff tears are likely to benefit from an anatomic total shoulder arthroplasty (TSA).

Glenohumeral arthritis is a degenerative joint disease of the shoulder characterized by damage to the articular surfaces of the humeral head and/or glenoid. Diagnosis is made radiographically. Treatment is observation, NSAIDs, and corticosteroids for minimally symptomatic patients. Shoulder arthroplasty is indicated for progressive symptoms with severe degenerative disease. Recent literature has demonstrated good outcomes with TSA even in the setting of partial rotator cuff tears, with or without repair.

Livesey et al. retrospectively evaluated patients who underwent concomitant anatomic total shoulder arthroplasty (TSA) and rotator cuff repair (RCR) for functional outcomes, revision rates, and predictors of poor results. They reported that patients with a preoperative acromiohumeral interval of less than 8 mm had an increased rate of cuff-related reoperation. They concluded that although concomitant TSA and RCR is a reasonable consideration, 31% of patients had a poor clinical result. An acromiohumeral interval of less than 8 mm was a predictor of cuff-related reoperation and may be an indication to consider reverse arthroplasty in the setting of joint arthrosis with a rotator cuff tear.

Ansok et al. reviewed glenohumeral osteoarthritis. They reported that treatment begins with non-operative measures, including oral and topical anti-inflammatory agents, physical therapy, and intra-articular injections of either a corticosteroid or a viscosupplementation agent. They concluded that operative treatment is based on the age and function of the affected patient, and treatment of young individuals with glenohumeral OA remains controversial.

Illustration A depicts the Walch classification for glenoid wear.

Incorrect Answers:
Answer 1: This patient would be at high risk for glenoid component loosening with a TSA given their young age and high-demand nature. A hemiarthroplasty may be a better option for this patient.
Answer 3: This patient likely has a rotator cuff tear after a TSA and should be converted to a reverse total shoulder arthroplasty (RSA).
Answer 4: This is a significant amount of posterior humeral head subluxation and RSA is often advocated when the humeral head has >80% posterior humeral head subluxation.
Answer 5: Anterior glenoid wear (Walch D) in an elderly patient would be best managed with a RSA.