Rotator Cuff Tears After Arthroplasty

Rotator cuff tears are an uncommon complication after total shoulder arthroplasty. The most common rotator cuff failure is failure of healing of the subscapularis. Takedown of the subscapularis is performed via tenotomy or lesser tuberosity osteotomy. Failure of healing leads to weakness and difficulty with internal rotation activities; however, catastrophic failure may lead to anterior instability. Subscapularis tears are treated with primary repair or pectoralis major transfer. Supraspinatus and infraspinatus tears are usually attritional and are often difficult to repair in the setting of a postoperative shoulder. Primary repair can be considered; however, the risk of failure is high because of poor tendon healing. Revision to reverse shoulder arthroplasty is an option in the setting of a symptomatic irreparable tear.