Reverse Shoulder Arthroplasty with Virtual Implant Positioning System in the Management of Massive Rotator Cuff Tear with Rotator Cuff Arthropathy.

INTRODUCTION: Massive irreparable rotator cuff tears associated with cuff tear arthropathy present a challenging clinical condition in elderly patients because of pain, loss of shoulder function, and progressive degenerative changes. Reverse shoulder arthroplasty (RSA) has emerged as the preferred surgical treatment by restoring shoulder biomechanics through medialization and inferiorization of the glenohumeral center of rotation. Recent advances, including computed tomography (CT)-based virtual implant positioning (VIP) systems, have further improved implant positioning accuracy and surgical planning. CASE REPORT: A 78-year-old right-hand-dominant female presented with progressive pain and functional limitation of the right shoulder following a slip-and-fall injury 1 month earlier. Clinical examination demonstrated painful restriction of shoulder movements with positive rotator cuff tests. Radiographs revealed acromioclavicular joint arthritis, whereas magnetic resonance imaging demonstrated full-thickness tears of the supraspinatus and infraspinatus tendons, a partial tear of the subscapularis tendon, Grade IV muscle atrophy, and rotator cuff arthropathy with moderate glenohumeral osteoarthritis. The patient underwent RSA using a CT-based VIP system. Glenoid preparation, baseplate fixation, glenosphere implantation, and humeral component placement were performed according to the pre-operative surgical plan, followed by a structured post-operative rehabilitation protocol. At the 10-month follow-up, the patient experienced complete pain relief, restoration of functional shoulder movements, and a successful return to activities of daily living without complications. CONCLUSION: RSA combined with VIP provided accurate implant placement, stable fixation, excellent functional recovery, and satisfactory clinical outcome in this patient with rotator cuff arthropathy.