Cuff tear arthropathy is best treated with a reverse total shoulder arthroplasty

Cuff tear arthropathy is the arthritic eroded collapse of the glenohumeral joint with progressive superior humeral migration in the setting of long-standing rotator cuff insufficiency. The ideal management of cuff tear arthropathy remains elusive. Current arthroplasty options include hemiarthroplasty or reverse shoulder arthroplasty. Proper clinical and radiographic evaluation is essential in decision making in order to optimize outcomes. Acromio-humeral distance (AHD), as measured on plain radiographs, as well as fatty degeneration of the rotator cuff muscles on MRI are reliable tools for decision making. AHD < 7 mm correlates well with complete tear of the supraspinatus while AHD < 5 mm indicates infraspinatus involvement with significant muscular atrophy. Hemiarthroplasty remains an option for providing pain relief; however, continued development of superior migration and glenoid erosion remains a concern. The conversion to reverse total shoulder arthroplasty after hemiarthroplasty can be difficult due to glenoid bone loss. Recent literature supports the use of reverse total shoulder arthroplasty over hemiarthroplasty for cuff tear arthropathy with significant differences in functional outcome. Here, we discuss the radiographic evaluation of cuff tear arthropathy and review the treatment options and why we advocate the use of the reverse prosthesis.