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What if the patient with an irreparable cuff tear and arthritis doesn't want a reverse total shoulder?

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What if the patient with an irreparable cuff tear and arthritis doesn't want a reverse total shoulder?



The right shoulder of a 60-year-old physically active electrician was damaged by a traumatic tear 16 years before the presentation. Gradually, the function of his shoulder decreased to the point where he could no longer return to work and other activities.  The symptoms worsened after a series of PRP treatments. A second surgeon suggested a reverse shoulder replacement, but the patient refused out of fear of complications and failure of polyethylene liners with his hobbies such as beekeeping and chopping wood.

When he presented, he had a painful crepitant right shoulder. There was only 70 degrees active elevation and only 140 passive degrees. He was weaker in his elevation and external rotaion, but had strong internal rotaion.  

Radiographs revealed glenohumeral osteoarthritis and suture anchors.

 

After a discussion of the alternatives, he desired to proceed with a CTA hemiarthroplasty (see this link). His supraspinatus, infraspinatus, and scapularis were irreparably torn at the time of surgery. His subscapularis is intact.


The radiograph below shows his postoperative radiograph.

After three months, he was able to return to his job as an electrical contractor with a fully functional shoulder. This is his active elevation after 3 months…



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