Cost-Effectiveness of Arthroscopic Rotator Cuff Repair Versus Reverse Total Shoulder Arthroplasty for the Treatment of Massive Rotator Cuff Tears in Patients With Pseudoparalysis and Nonarthritic Shoulders

Authors:

Grant J Dornan, J Christoph Katthagen, Dimitri S Tahal, Maximilian Petri, Joshua A Greenspoon, Patrick J Denard, Stephen S Burkhart, Peter J Millett

Abstract:

The prevalence of full-thickness rotator cuff tears (RCTs) in the general population has been reported to be about 20%, with one-third of these RCTs being symptomatic. In the United States, more than 275,000 rotator cuff repairs (RCRs) of symptomatic RCTs are being performed every year, and the frequency is increasing. Approximately 25% of RCTs are massive rotator cuff tears (MRCTs) with involvement of 2 or more tendons or a tear dimension of >5 cm. The surgical treatment of MRCTs is challenging, with treatment options ranging from arthroscopic repair to reverse total shoulder arthroplasty (RTSA).

Pseudoparalysis (PP) represents a condition of the shoulder with active elevation of less than 90 in association with full passive elevation. Almost 20% of patients with MRCTs are affected by PP, and it has been shown previously that PP can be reversed effectively with arthroscopic RCR (ARCR). Although RTSA initially was introduced as a treatment option for cuff tear arthropathy, the indications for RTSA have expanded to include the treatment of MRCTs with PP and without osteoarthritis (OA). In fact, RCTs recently were identified as the second most common indication (21%) for RTSA implantations in the United States.

These 2 treatment options for PP without OA, ARCR, and RTSA have their own potential limitations. ARCR for MRCTs has been shown previously to be associated with fairly high rates of retear (especially with increasing initial tear size) and with associated deterioration of functional outcomes. RTSA, in contrast, can result in complications that include dislocation, scapular notching, and baseplate loosening in addition to infection. Moreover, limited information currently is available on long-term survivorship after RTSA, and many experts suggest that RTSA should be reserved for elderly patients.

Therefore, the best treatment for patients with PP without OA remains unclear. Although some surgeons prefer ARCR, others advocate RTSA for this condition. As the result of increasing medical costs, the cost- effectiveness of orthopaedic procedures increasingly is gaining importance in the current health care climate. The aim of this study was to determine the most cost-effective treatment strategy for patients with MRCTs and PP without OA. Specifically, we aimed to compare ARCR versus RTSA and investigated the effect of patient age on this decision. We hypothesized that ARCR would be more cost-effective than RTSA for the treatment of PP without OA.

For the complete study: Cost-Effectiveness of Arthroscopic Rotator Cuff Repair Versus Reverse Total Shoulder Arthroplasty for the Treatment of Massive Rotator Cuff Tears in Patients With Pseudoparalysis and Nonarthritic Shoulders

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

Submit your review
Name:
Email:
Website:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

Cost-Effectiveness of Arthroscopic Rotator Cuff Repair Versus Reverse Total Shoulder Arthroplasty for the Treatment of Massive Rotator Cuff Tears in Patients With Pseudoparalysis and Nonarthritic Shoulders

Authors:

Abstract:

About the Author: Peter Millett, MD