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The versatile, inexpensive and safe CTA hemiarthroplasty for patients with preserved active elevation

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The cuff tear arthropathy (CTA) hemiarthroplasty – using an extended humeral articular surface that articulates with the coracoacromial arch – is a versatile, effective and inexpensive reconstructive procedure for shoulders with cuff deficiency, arthritis and active elevation beyond 90 degrees. See Treating cuff tear arthropathy in the active patient – the CTA prosthesis. The technical details for this procedure are shown in this link.  In contrast to the reverse total shoulder arthroplasty, the CTA hemiarthroplasty avoids the risks of dislocation, acromial and scapular spine fractures, notching, baseplate loosening, glenoid fracture, and dissociation of the glenosphere from the baseplate.

Yesterday, we saw three patients in followup after this procedure demonstrating its application for different shoulder pathologies.

Case 1.

A man in his sixties had a proximal humeral fracture treated previously with plate fixation. This was complicated by loss of fixation and avascular necrosis. Preoperatively he had active flexion >90 degrees and the x-rays shown below.

At surgery the supraspinatus and infraspinaturs were absent. The plate and humeral head were removed and a CTA hemiarthroplasty with reconstruction of his subscapularis was performed. Eight years after surgery he returned for routine followup. His x-rays at that time are shown below.



His shoulder comfort and function were good with active elevation of 150 degrees as shown below.


Case 2. 

A man in his seventies presented with pain and stiffness of the left shoulder after a failed rotator cuff repair. He had active elevation above 90 degrees. His preoperative images showed cuff tear arthropathy, heterotopic bone and retained suture anchors.

At surgery he was found to have no supraspinatus or infraspinatus. He had a CTA hemiarthroplasty with debridement of unwanted bone and suture anchors. His subscapularis was reconstructed.

He returned six weeks after surgery with good comfort of the shoulder and active elevation greater than 90 degrees at this early stage of his rehab. His x-ray at that time is shown below.


Case 3.

A man in his seventies presented with pain and loss of function in his right shoulder. He had active elevation greater than 90 degrees. His preoperative x-rays are shown below.



At surgery he had no supraspinatus or infraspinatus. His subscapularis was reconstructed.

Three years after surgery he returned for routine followup. His x-rays at that time are shown below.



He had comfortable active elevation of 160 degrees as shown below.


Comment: As reported by the authors of  Clinical effectiveness and safety of the extended humeral head arthroplasty for selected patients with rotator cuff tear arthropathy, the CTA hemiarthroplasty is a safe and effective treatment for patients with cuff tear arthropathy and retained active elevation. It is substantially less expensive than a reverse total shoulder and does not require preoperative CT scans or 3D planning.

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