Rotator Cuff-Tear Arthropathy (CTA) is an arthritic condition that occurs when you have a large rotator cuff tear for an extended period of time. It is the combination of a massive rotator cuff tear and the collapse of the surface of the upper arm bone (humerus). People with cuff-tear arthropathy typically experience severe pain and very limited movement.

Your surgeon decides what procedure to use based on the extent of damage to the shoulder bones and surrounding tissues. Rotator cuff (def.)Rotator Cuff The rotator cuff is a muscle tendon unit composed of four muscles that attach the humeral head ("ball" of the upper arm bone) to the scapula (shoulder blade). and orthobiologic implants repair more severely damaged shoulders. In a study of hundreds of patients who had shoulder surgery, more than 95% reported having less pain afterwards.¹

The rotator cuff attaches the shoulder to the upper arm and helps the arm move in a circular fashion. The ball and socket of the shoulder joint move smoothly if the cartilage stays healthy and the surrounding muscles, tendons and ligaments remain intact. However, disease, trauma, or a lifetime of “wear and tear” can injure the rotator cuff and destroy underlying bones.

Healthy Rotator Cuff

Torn Rotator Cuff

Shoulder with Implant

When the rotator cuff muscles have been torn, and the shoulder joint has become arthritic and painful, it can be difficult to raise the arm above shoulder level. This condition is called cuff tear arthropathy. The DePuy Global Advantage CTA Humeral Head (def.)Humerus The humerus is the long arm bone located between the shoulder and elbow. The upper portion of the humerus (humeral head) is the "ball" at the top of the arm bone. addresses the surgical issues related to this arthritic condition.

Another option, the DePuy Global AP CTA Shoulder provides the latest advancement in a trusted line of shoulder implants from DePuy that dates back decades. Your shoulder joint is as unique as you are. The variation from person to person is due to differences in size, shape and angle of the bones, as well as other natural variations. With the DePuy Global AP CTA Shoulder, your surgeon can choose the optimal shoulder implant to help reduce your pain and restore the smooth, natural movement of the shoulder.

The DePuy Global Advantage CTA and DePuy Global AP CTA shoulder implants are designed to replace the ball portion of the shoulder joint called the humeral head. They attach to the top of a metal stem that fits into the upper arm bone (humerus), anchoring the implant in place.

One major problem with total shoulder replacement for cuff tear arthropathy is encountered when the rotator cuff tendons (def.)Tendons Tendons are cord-like structures made of collagen that connect muscles to bones. cannot be repaired. They have become too scarred and weakened to effectively raise the arm from the side. The DePuy Global CTA family of implants are designed to reduce friction, which may allow the deltoid muscle to raise the arm higher even when the rotator cuff tendons cannot be repaired.

The DePuy Global Advantage and the DePuy Global AP CTA shoulder implants are designed with a larger articular surface, the area where the joint rotates, than a traditional shoulder replacement for a more natural fit and greater range of motion. As the deltoid muscle raises the arm, the implant surface remains in contact with the socket longer. This helps the deltoid raise the arm higher by itself.

• A DePuy Global CTA implant can be used in patients who have cuff tear arthropathy or rotator cuff tendons that cannot be repaired
• In most cases, the surgeon will have a good idea that a CTA implant may be required in advance, but the decision may also be made at the time of surgery

DePuy Restore^® Orthobiologic Implant

The DePuy Restore orthobiologic implant is the first of its kind and has changed the treatment of soft tissue tears and damage. Developed through a partnership between Purdue University and DePuy, the Restore implant provides an absorbable brace to strengthen soft tissue repair.

The traditional treatment for reinforcing lost or damaged tissue has been transplanting bone or tissue. The DePuy Restore implant gives the surgeon a less invasive treatment when the rotator cuff tissue is of poor quality or the repair needs reinforcement.

While the body regenerates damaged tissues, the DePuy Restore implant reinforces the repaired soft tissue and provides a framework around which the body builds new tissue. As new tissue grows, the DePuy Restore implant slowly dissolves until all that remains is your tissue. The 10-layer thick implant is strong yet very thin and can easily be cut into any shape needed to repair the injury.

The implant, derived from the lining of a pig's small intestine, has been cleansed, processed, and sterilized. The DePuy Restore implant was extensively tested for safety before being introduced. High level safeguards have been implemented to eliminate the potential for infection or disease transmission.

Damage to the rotator cuff is often difficult to repair because so much soft tissue has been destroyed. The DePuy Restore Implant stabilizes soft tissue repairs while the body gradually heals. As the implant slowly dissolves, it will be replaced by tissue rather than a transplant.

Reactions or rejection of the material could occur, particularly if you have a history of multiple or severe allergies, an overly sensitized immune system, or if you have a sensitivity to pork products. Keep in mind that soft tissue repair is surgery, and with any surgery there may be general adverse effects or complications. These include:

• Infection
• Injury to nerves and blood vessels
• Fractures
• Weakness
• Stiffness or instability of the joint
• Pain
• Inability to repair a tendon
• Re-rupture
• General risks associated with surgery and anesthesia

There are also a few related risks associated with Restore:

• Stretching or tearing of the implant
• Stiffness
• Chronic inflammation or swelling
• Longer rehabilitation period
• Failure of the implant to be replaced by natural tissue
• Immunological reaction

Note

Only an orthopaedic surgeon trained in shoulder replacement can provide advice about whether shoulder replacement surgery is right for you. See your physician to learn more. As with any surgery, there are risks, and results may vary depending on your age, weight, activity level, preoperative condition, and other factors. People with current infections or conditions limiting rehabilitation should not have this surgery. The most common adverse events after joint replacement are loosening, infection, and fracture of the prostheses or bones. You and your surgeon must weigh the risks of surgery against its possible benefits.

Adverse Events

The following are the most frequent adverse events after shoulder arthroplasty: change in position of the component, loosening of components, dislocation, infection, hematoma, pneumonia, and cardiovascular disorders.

References