Repairing rotator cuff tears at the time of anatomic total shoulder replacement

Repair of a rotator cuff tear at the time of anatomic total shoulder replacement is critical. Patients with osteoarthritis of the shoulder that have no symptoms of rotator cuff deficiency may have at the time of surgery rotator cuff tears that need repair. Prior to surgery the patients are examined for obvious symptomatic rotator cuff tears, however if the surgeon encounters a torn cuff at the time of anatomic shoulder replacement then it is mandatory to proceed with repair. Such a repair will slow down the recovery and rehab protocol of the patient at the benefit of decreased chance of early loosening and failure of the glenoid component. For further reading please refer to:

Anatomical total shoulder replacement with rotator cuff repair for osteoarthritis of theshoulder. Simone JP, Streubel PH, Sperling JW, Schleck CD, Cofield RH, Athwal GS.

Bone Joint J. 2014 Feb;96-B(2):224-8

Results of cemented total shoulder replacement with a minimum follow-up of ten years. Raiss P, Schmitt M, Bruckner T, Kasten P, Pape G, Loew M, Zeifang F.

J Bone Joint Surg Am. 2012 Dec 5;94(23):e1711-10. 

The following case is a 70 y/o female with a long history of shoulder pain due to glenohumeral osteoarthritis. She failed conservative treatment and at the time of presentation she had intact rotator cuff strength. Preoperative radiographs indicate degeneration of the footprint of the supraspinatus with formation of the a large osteophyte at the footprint of the supraspinatus. In addition the so called "bone spur" is visible on the acromial side. Although this radiographic finding is indicative of degenerative tear of the supraspinatus it needs to highlighted that it not diagnostic. At the time of surgery she did have a 2 cm tear of the supraspinatus that was repaired. We elected not to remove the osteophyte because this would have required violation of the intact fibers of the supraspinatus. She was pain free at 4 months postop. Preoperative and postoperative Xrays are illustrated below. It is important to educate patients that "bone spurs" are not always the cause of pain.