Reverse total shoulder arthroplasty for irreparable rotator cuff tears without arthritis: A systematic review

Indications for reverse total shoulder arthroplasty (RTSA) have expanded over recent years. Whilst cuff tear arthropathy is an accepted indication, the results of its use in those without arthritis is not clear. The aim of this article is to review the literature on RTSA for massive rotator cuff tears without associated arthritis.

A systematic review search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to find all studies with clinical outcomes on RTSA performed for massive irreparable rotator cuff tears (MIRCT) without arthritis.

Of the 160 studies produced by the search, a detailed analysis found 11 articles to be included in this review. There was variability in the implant style used and the outcome measures utilised, but all studies found improvement in the outcome following RTSA. Many studies advised judicious use following high complication rates, and caution was advised in those patients with pre-operatively preserved active forward elevation.

The available evidence suggests that RTSA is a reliable option in older patients with persistent pain and lack of function following MIRCT even without arthritis. However, as outcomes are not significantly worse following failed rotator cuff repair, joint preserving options in the younger age group should be carefully considered in light of the relatively high complication rate associated with RTSA.

IV.