Cuff tear after arthroplasty: Holes a poppin'

Rotator cuff tears are a recognized complication after total shoulder arthroplasty. They occur in as many as 2% to 8% of patients. Many tears may be unrecognized and related to aging and the natural history of cuff disease. Some tears may result in significant disability and require operative treatment. Results of primary repair are mixed and healing likely unreliable. Operative indications include pain, symptomatic weakness, and sudden onset loss of function. Postoperative tears are best prevented by appropriate sizing of components, version, and careful technique. Recently, attention has focused on subscapularis function and integrity after shoulder arthroplasty. There is a high rate of failure of subscapularis repair and dysfunction even in intact tendons. Many subscapularis problems are asymptomatic, but others lead to instability. Improvements in technique may result in more reliable healing and function after total shoulder arthroplasty.