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Shoulder Arthroplasty

Shoulder Arthroplasty. Kelton Burbank, MD Ramsey Rehab Lecture Series October 27, 2009. Anatomy. Historical Perspective. 1893 French Surgeon Pean had a platinum and rubber total joint fashioned by a local dentist Inserted into a 37 yo baker with TB Arthritis

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Shoulder Arthroplasty

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  1. Shoulder Arthroplasty Kelton Burbank, MD Ramsey Rehab Lecture Series October 27, 2009

  2. Anatomy

  3. Historical Perspective • 1893 French Surgeon Pean had a platinum and rubber total joint fashioned by a local dentist • Inserted into a 37 yo baker with TB Arthritis • Removed 2 yrs later for recurrent Infection

  4. Historical Perspective • 1953 Neer replaced fx proximal humerus • 1971 used TSA for RA and OA • Initial Prosthesis (Neer) had 3 sizes

  5. Prevalence • 1990-1993 < 5000/yr Shoulder Arthroplasties • 1998 - 15,266 procedures • Compared to 540,000 Hip and Knee in 1998 • 2-3% of all Arthroplasties

  6. Clinical Indications • Osteoarthritis • Inflammatory Arthritis • Osteonecrosis • Rotator Cuff Arthropathy • Fracture • Tumor

  7. INDICATIONS • GLENOHUMERAL JOINT ARTHRITIS RESULTING IN: • PAIN • LOSS OF MOTION • LOSS OF FUNCTION

  8. OTHER TREATMENT OPTIONS • ACTIVITY MODIFICATION • NSAIDS/TOPICAL ANALGESICS • PT* • USUALLY ELICITS PAIN • INJECTIONS • CORTISONE • HYALURONIC ACID • ARTHROSCOPY • FUSION

  9. Other Options: Fusion • Young • Heavy Laborer • Poor function of Rotator Cuff and Deltoid • Infection • Decreasing Indications

  10. ARTHROSCOPY • Lavage/debridement • Capsular release • Removal of loose bodies • Biceps tenotomy • Distal clavicle excision • Subacromial decompression* • Debridement of rotator cuff tear

  11. Arthroscopy

  12. Arthroscopy

  13. TYPES OF SHOULDER REPLACEMENT • RESURFACING • HEMI • REGULAR • CTA HEAD • TOTAL • REVERSE

  14. Resurfacing • Young patients • Preserve bone • Glenoid?

  15. Hemiarthroplasty • INDICATIONS • Uninvolved Glenoid • Osteonecrosis • Proximal Humerus Fx • Osteoarthritis • Rheumatoid Arthritis? • Unstable forces on Glenoid • Significant Rotator Cuff Tear

  16. HEMI:Cuff Tear Arthropathy (CTA) • Large Rotator Cuff Tear • Indicated for high riding stable humeral head • No Anterior Escape • “Iatrogenesis Imperfecta”

  17. Total Shoulder Arthroplasty • Indication • Pain Relief • Contraindications • Nerve deficits • Noncompliant pts • ? Infection • Rotator cuff deficiencies

  18. TOTAL SHOULDER ARTHROPLASTY

  19. Complications TSA • Glenoid loosening • Humeral loosening • Glenoid wear (hemi) • Instability • Rotator cuff tears • Periprosthetic Fx • Infection • Nerve Injuries

  20. REVERSE TSA

  21. Biomechanical Theory

  22. REVERSE TSA • Complication Rate • Durability • Revision?

  23. DELTA ↓ →

  24. Post Operative Rehab • TSA • Check range in OR • Start AAROM POD 1 • Active ROM as tolerated • Protect Subscap 4-6 weeks • Strengthening at 4-6 weeks

  25. Activities after TSA

  26. Decision Algorithm in Rotator Cuff Tears with OA

  27. Decision Algorithm in Rotator Cuff Tears with OA

  28. Thank You

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