Home Clean Living CTA hemiarthroplasty or reverse total shoulder for cuff tear arthopathy? It depends.

CTA hemiarthroplasty or reverse total shoulder for cuff tear arthopathy? It depends.


Shoulders with cuff tear arthropathy (CTA), 

can be successfully treated with 
CTA hemiarthroplasty (CTA-H, hemiarthroplasty with an extended humeral articular surface) provided that the shoulder has active glenohumeral elevation and an intact coracoacromial arch

or with a reverse total shoulder arthroplasty (RSA) 

The RSA is more expensive and has complications including, instability, acromial and scapular fractures, baseplate failure, and scapular notching that are not seen with the CTA-H.

The Simple Shoulder Test (SST) was used as a joint-specific patient-reported outcome measure of comfort and function. Improvement in quality adjusted life years (QALYs) was measured using the Short-Form 36 (SF-36). 

Costs associated with inpatient care were collected from hospital financial records.

Significant improvements in SST and SF-36 physical component scores were seen in both groups. 

Inpatient hospitalization costs were significantly higher in the RSA group compared to the CTA-H group ($15,074 ± $1,614 vs. $10,389 ± $1,948, p<0.001) driven primarily by supplies including the cost of the prosthesis ($9,005 ± $2,521 vs. $4,715 ± $2,091, p<0.001). 

Both procedures led to significant improvements in HRQoL and joint-specific measures:

SST comparison at two years after surgery:

SF36 Physical Component Summary comparison at two years after surgery:

SF 36 Mental Component Summary comparison at two years after surgery:

The revision rate for RSAs was twice that of CTA-Hs: 12% of the RSAs and 5% of the CTA-H shoulders required revision.

The diagnosis of diabetes was an independent predictor of higher inpatient hospitalization costs for both groups. 

Comment: It is of note that this study did not compare the two types of arthroplasty in patients with similar preoperative characteristics. Instead it compared the outcomes of the more conservative, less expensive CTA-H in shoulders with retained active elevation, intact coracoacromial arch, and intact subscapularis to the outcomes of RSA in patients in shoulders that did not meet these indications for CTA-H.  

The results suggest that the cost-effectiveness of shoulder arthroplasty for cuff tear arthropathy may be optimized by reserving RSA for cases of CTA that cannot be managed with the extended humeral head CTA-H arthroplasty.

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