It's good to be here. My name is Daisuke Marikyo, Japan. So we have an accomplished interest. In operatively treating an elderly patient with granulohumeral arthritis, GHOA, with an intact calf, rotator cuff tears following TSA is a big issue at reported different rates. RSA is an increasingly popular option for such patients because of advanced technology. However, which option is better remains controversy among orthopedic surgeons. So to solve such controversy, we conducted the two comparisons. First, we histologically analyzed the tongue edge of the calf tendon by harvesting calf tissue from patient with GHOA or a calf tear arthritis CTF patient or patient with a proximal humeral fracture at the time of the reverse shoulder arthroplasty. Second, we compared the clinical and radiographic outcomes for patients who underwent TSA or RSA when this patient reaches over 80 years of the age in TSA or RS group. We harvest the tendon samples, 15 samples in three shoulders in two patients with OA and 24 samples in 20 patients with CTA and three samples in three patients with a proximal humeral fracture for control shoulder. And we compared the clinical and radiographic assessment for seven shoulders in six patients for TSA as a TSA group and 90 shoulders in 50 patients for RSA as a RSA group. We identified the secondary dysfunction by presence of either moderate or severe superior sublocation on the radiographic assessment according to the Yang et al. criteria. We used a histological analysis using a Bonnard score. We measured the femoral diameter and observed the histological section using a transmission electron microscopic analysis. There are no significant differences in the Bonnard score between the CTA and OA patient. Histological findings and appearance were similar in the patient with OA and the CTA groups. There are no significant differences in the femoral diameter in the CTA and OA patient. Regarding a Bonnard score in counterpatient, the scores ranged from zero to six as a mean 2.7 points. However, case three had Walsh et al. deformity as a sixth of the Bonnard score. So case one and case two showed the well-oriented collagen fibers with tightly cohesive well-demarcated bundles. Regarding a comparison of clinical outcomes, so RSA group was superior to RSA group in terms of constant RON score and flexure. For shoulders, 57.1 points shoulder developed calf dysfunction as a moderate sublocation. Important findings in this study was shown. Similar tendon degeneration in TSA and RS group and 57.1% of second calf dysfunction in TSA group possibly because of a fragile calf tendon based on the results of fiber diameter. RSA group was superior to TSA group in terms of constant score and RON. RSA and RS groups of the Bonnard score was higher than the scores of the counterpatient. And case three had a H. granuli. So Yang et al. showed the 55% of the calf dysfunction, 15% aperitif. Based on the result and our result, in conclusion, elderly patients with OA without calf tears had potentially severe histological degeneration of the rotated calf tendon which may be possible risk factor for secondary rotated calf dysfunction and poor clinical outcomes after TSA. Thank you for attention. Thank you.

elderly patients

total shoulder arthroplasty

reverse shoulder arthroplasty

calf dysfunction

clinical outcomes