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Reverse Total Shoulder Arthroplasty for Repair of Failed Shoulder Hemiarthroplasty in a Young Patient: A Case Report<br />...
Background<br /><ul><li>Shoulder Arthropathy
RC Tears, RA, OA, Impingement, Fractures
Causes ↑ pain, ↓ ROM, ↓Strength, ↓ Function
TSA & hemiarthroplasty current standard of treatment</li></li></ul><li>Background<br /><ul><li>rTSA
Reverses normal anatomical design
Utilizes deltoid to compensate for deficient RC
Yields ↓ pain, ↑  ROM, ↑  Strength,  ↑ Function
Traditionally been reserved for older patients</li></li></ul><li>Objectives<br />The objectives of this case report were t...
Describe the minimal direct supervision post-op rehab program. </li></li></ul><li>Subject<br /><ul><li>Right-handed Caucas...
 Traumatic dislocation at age 18
 Multiple Stabilization procedures over 30 years
Received hemiarthroplasty at age of 49
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Reverse Total Shoulder Arthroplasty Research Presentation

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Reverse Total Shoulder Arthroplasty Research Presentation

  1. 1. Reverse Total Shoulder Arthroplasty for Repair of Failed Shoulder Hemiarthroplasty in a Young Patient: A Case Report<br />Sam Vaid, Tyler Shultz, Craig Garrison, Lori Bolgla <br />
  2. 2. Background<br /><ul><li>Shoulder Arthropathy
  3. 3. RC Tears, RA, OA, Impingement, Fractures
  4. 4. Causes ↑ pain, ↓ ROM, ↓Strength, ↓ Function
  5. 5. TSA & hemiarthroplasty current standard of treatment</li></li></ul><li>Background<br /><ul><li>rTSA
  6. 6. Reverses normal anatomical design
  7. 7. Utilizes deltoid to compensate for deficient RC
  8. 8. Yields ↓ pain, ↑  ROM, ↑  Strength,  ↑ Function
  9. 9. Traditionally been reserved for older patients</li></li></ul><li>Objectives<br />The objectives of this case report were to:<br /><ul><li>Document functional outcomes in a patient who underwent rTSA.
  10. 10. Describe the minimal direct supervision post-op rehab program. </li></li></ul><li>Subject<br /><ul><li>Right-handed Caucasian male (age = 50 yrs; height = 180 cm, mass = 99.8 kg)
  11. 11. Traumatic dislocation at age 18
  12. 12. Multiple Stabilization procedures over 30 years
  13. 13. Received hemiarthroplasty at age of 49
  14. 14. Underwent  rTSA procedure for revision of failed hemiarthroplasty</li></li></ul><li>Treatment<br />Check-Ups every 2 months with rehab team<br /> Home based rehab program <br />
  15. 15. Results<br /><ul><li>Subject had clinically significant improvements in
  16. 16. ROM, Function, Pain
  17. 17. Active IR ↑ from Rt. Iliac crest to L1
  18. 18. Most apparent ↑ was in functional level
  19. 19. Initiated golf, tennis, fishing 4 months post
  20. 20. Full recovery without any limitations with these activities 8 months post
  21. 21. Radiographs taken 8 months post
  22. 22. Prosthesis secure & in place
  23. 23. No baseplate loosening</li></li></ul><li>Discussion<br />Limited info on rTSA post-op rehab<br /><ul><li>Most literature pertains to older populations
  24. 24. Currently no standard guidelines/protocols</li></ul>Unique case<br /><ul><li>Youngest pt. to undergo procedure by the orthopedic team
  25. 25. Pt.’s Hx of traumatic shoulder injury
  26. 26. Pt.’s high activity level</li></li></ul><li>Limitations<br />Lack of standardized outcome measures<br />Inconsistent strength testing<br />Unknown exercise duration, repetitions, & intensity<br />
  27. 27. Conclusions<br />HCP’s should consider rTSA in younger patients<br />A standardized rehabilitation protocol should be developed to return patients to optimal function after surgery<br />
  28. 28. Bottom Line<br />“rTSA was effective at increasing ROM, strength, and functional activity in a highly active male who experienced failed hemiarthroplasty for traumatic RC arthropathy”<br />The results suggest that rTSA may be a viable option for younger, highly active patients<br />
  29. 29. Questions<br />
  30. 30. References<br />1. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8(4):296-299.<br />2. Levy J, Virani N, Pupello D, Frankle M. Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with<br />glenohumeral arthritis and rotator cuff deficiency. Journal of Bone and Joint Surgery. 2007;89(2):189.<br /> 3. Rittmeister M, Kerschbaumer F. Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff<br />lesions. J Shoulder Elbow Surg. 2001;10(1):17-22.<br />4. Middernacht B, De Wilde L, Molé D, Favard L, Debeer P. Glenosphere Disengagement: A potentially serious default in reverse shoulder surgery. <br />Clinical Orthopaedics and Related Research. 2008;466(4):892-898.<br /> 5. Frankle M, Siegal S, Pupello D, et al. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A <br />minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87(8):1697-1705.<br /> 6. Guery J, Favard L, Sirveaux F, et al. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J <br />Bone Joint Surg Am. 2006;88(8):1742-1747.<br /> 7. Roberts C, Ekelund A, Renfree K, Liu P, Chew F. Radiologic assessment of reverse shoulder arthroplasty. RadioGraphics. 2007;27:223-235.<br /> 8. Drake GN, O'Connor DP, Edwards TB. Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease. ClinOrthopRelat Res. 2010. <br />Available at: http://www.ncbi.nlm.nih.gov/pubmed/20049573 [Accessed April 16, 2010].<br /> 9. Wall B, Nové-Josserand L, O'Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone <br />Joint Surg Am. 2007;89(7):1476-1485.<br /> 10. Wierks C, Skolasky R, Ji J, McFarland E. Reverse Total Shoulder Replacement: Intraoperative and Early Postoperative Complications. Clinical <br />Orthopaedicsand Related Research®. 2009;467(1):225-234.<br /> 11. Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral <br />fracture. J Bone Joint Surg Am. 2007;89(2):292-300.<br /> 12. Seebauer L, Walter W, Keyl W. Reverse total shoulder arthroplasty for the treatment of defect arthropathy. OperOrthopTraumatol. 2005;17(1):1-24.<br /> 13. Hatzidakis A, Norris T, Boileau P. Reverse Shoulder Arthroplasty Indications, Technique, and Results. Techniques in Shoulder & Elbow Surgery. <br />2005;6(3):135-149.<br /> 14. Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.<br /> 15. Proaxis Therapy. Reverse Total Shoulder Arthroplasty Patient Flow Sheet. 2007.<br /> 16. Boudreau S, Boudreau E, Higgins L, Wilcox R. Rehabilitation following reverse total shoulder arthroplasty. Journal of Orthopaedic and Sports <br />Physical Therapy. 2007;37(12):734-743.<br /> 17. Kontaxis A, Johnson GR. Adaptation of scapula lateral rotation after reverse anatomy shoulder replacement. Computer Methods in Biomechanics & <br />Biomedical Engineering. 2008;11(1):73-80.<br /> 18. Walch G, Mottier F, Wall B, et al. Acromial insufficiency in reverse shoulder arthroplasties. Journal of Shoulder and Elbow Surgery. In Press, Corrected Proof. Available at: <br />http://www.sciencedirect.com/science/article/B6WM1-4VPV8X4-1/2/881dff574c6de509102f666da98c6146 [Accessed March 14, 2009].<br />19. Gutiérrez S, Greiwe RM, Frankle MA, Siegal S, Lee WE. Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder <br />Elbow Surg. 2007;16(3 Suppl):S9-S12. <br />20. Bergmann J, de Leeuw M, Janssen T, Veeger D, Willems W. Contribution of the Reverse Endoprosthesis to Glenohumeral Kinematics. Clinical Orthopaedics and Related Research. <br />2008;466(3):594-598.<br />

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