[Shoulder arthroplasty following rotator cuff tear: acquired arthropathy of the shoulder]

The treatment of cuff tear arthropathy (CTA) of the shoulder is based on the patient's subjective complaints, functional deficits, and the treatment goals that result from both. Only in the second line is the radiologic morphology of joint destruction important for the surgeon's decision. Based on these aspects it is possible to discriminate three types of CTA that obviously have similar functional deficits and radiological characteristics. This symptom-based classification can offer decision guidelines for the choice of an appropriate joint replacement.For the most frequent, stable, and osteoarthritic type with pain during motion and a tolerably restricted active and passive range of motion (ROM) surface replacement or hemiarthroplasty can lead to reasonable results. In the unstable type with only minimal radiological changes of the humeral head and the chief complaint of severe restriction of active ROM and in some cases recurrent shoulder dislocations, hemiarthroplasty with a glenoid reconstruction shell or reversed prosthesis are promising. A reverse prosthesis is the implant of choice for the necrotic type of CTA with extensive destruction of the humeral head, the glenoid, and the adjacent bony structures.