Clinical comparison of humeral-lateralization reverse total shoulder arthroplasty between patients with irreparable rotator cuff tear and patients with cuff tear arthropathy.

Background: This study aimed to compare the clinical and radiologic outcomes between patients with irreparable cuff tears (ICTs) and those with cuff tear arthropathy (CTA) after reverse total shoulder arthroplasty (RTSA) with a humeral-lateralization prosthesis.

Methods: A total of 127 patients with ICTs and CTA who underwent RTSA were enrolled and matched at a 1:2 ratio by propensity score. Preoperative shoulder function was assessed for all patients. Radiologic parameters including the acromion-deltoid tuberosity (ADT) distance, lateral humeral offset, and scapular notching were evaluated.

Results: Thirty-four patients in the ICT group and 68 patients in the CTA group were matched for comparison. Preoperatively, mean active forward flexion in the ICT group (89.7° ± 29.4°) was significantly better than that in the CTA group (65.5° ± 24.0°, < .001). In the CTA group, fatty infiltration of the supraspinatus was worse (3.7 ± 0.5) and the ADT distance was shorter (134.0 ± 12.0 mm) compared with the ICT group preoperatively (3.3 ± 0.8 [ = .008] and 140.7 ± 12.5 mm [ = .001], respectively). There was no significant difference in postoperative functional or radiologic outcomes between the 2 groups. However, gains in active forward flexion (37.9° in ICT group vs. 61.5° in CTA group, < .01) and abduction (42.1° in ICT group vs. 60.6° in CTA group, < .01) were significantly greater in the CTA group than in the ICT group.

Conclusions: Shoulder function was significantly improved after RTSA regardless of the preoperative diagnosis. Postoperatively, radiologic findings were not significantly different between the 2 groups. Due to the fact that preoperative range of motion and rotator cuff status were better in patients with ICTs, improvements in active forward flexion and abduction were significantly greater in patients with CTA.