Review Question - QID 398

Significant irreparable rotator cuff tears represent a contraindication to standard total shoulder arthroplasty.

Options in a rotator cuff deficient patient include no glenoid resurfacing (hemiarthroplasty) or placement of a reverse total shoulder, but not a standard all-poly or metal-backed poly glenoid component.

If a patient has an irreparable rotator cuff tear, they will have abnormal mechanics and often develop degenerative changes referred to as rotator cuff arthropathy. The abnormal mechanics will persist even after standard total shoulder arthoplasty components are placed, with the head levering on the superior glenoid (the "rocking horse” phenomenon) which may loosen the glenoid component. In this situation, a hemiarthroplasty or a reverse total shoulder arthroplasty would be preferrable.