Prevalence and projections of total shoulder and elbow arthroplasty in the united states to 2015. Reverse shoulder arthroplasty can be an efficacious salvage procedure in the management of failed arthroplasty due to rotator cuffrelated instability or bone defects, or both. The head of the upper arm bone humerus is the ball and a circular depression glenoid in the shoulder bone scapula is the socket. The purpose of this study was to evaluate the outcomes after a minimum of 10 years, and to document prosthetic. Reverse total shoulder arthroplasty what is reverse total shoulder arthroplasy rtsa. Current outcomes following reverse total shoulder arthroplasty. The reverse shoulder prosthesis rsp is an orthopaedic device used in shoulder endoarthroplasty and an important therapeutic option in glenohumeral arthropathies with major injuries of the rotator cuff. The reverse total shoulder arthroplasty was introduced to treat the rotator. But patients who dont have enough muscle function to stabilize the joint may not be able to benefit from the traditional implant design one that mimics the normal anatomic shoulder. Each case can be very different depending on the goals of the patient, the age of the. Paff the intent of this protocol is to provide the clinician with guidelines of the postoperative rehabilitation of someone undergoing total shoulder arthroplasty or hemiarthroplasty. Bradley edwards provide stepbystep details for each category of. Before suggesting the operation, your doctor will have considered that the benefits of having the operation outweigh any disadvantages. Avoidance of shoulder extension past neutral, as well as the combination of shoulder adduction and internal rotation reaching behind your back, should be avoided for twelve 12 weeks postoperatively.
Despite the increasing numbers of reverse total shoulder arthroplasty rtsa procedures, the longterm results have been rarely reported. It was the purpose of this study to analyze longterm outcomes and complications of rtsa for irreparable rotator cuff tears in patients younger than 60 years. We previously reported early outcomes of a cohort of patients treated with a grammontstyle rtsa. Reverse shoulder arthroplasty rsa may be indicated in displaced proximal. There has been serious concern regarding the longevity and durability of outcomes of reverse total shoulder arthroplasty rtsa in younger patients. Department of rehabilitation services reverse total. Reverse shoulder replacement has become increasingly popular for people with serious shoulder pain, immobility and rotator cuff injuries. This is because the articular surface of the round humeral head is approximately four times greater than.
Allow healing of soft tissue maintain integrity of replaced joint gradually increase shoulder passive range of motion, restore elbowwristhand active range of motion reduce pain and inflammation. Clinical results of revision shoulder arthroplasty using. There are a few significant differences in postoperative guidelines between a total shoulder arthroplasty tsa and reverse shoulder arthroplasty rsa primarily due to rotator cuff arthropathy. Pdf complications in reverse shoulder arthroplasty researchgate. A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. The indication for reverse shoulder arthroplasty rsa is most commonly rotator cuff disease in association with glenohumeral arthritis. Functional outcome of hemiarthroplasty compared with reverse total shoulder arthroplasty in the treatment of rotator cuff tear arthropathy. Rehabilitation protocol for reverse shoulder arthroplasty.
Typically these patients have had a hemiarthroplasty placed for cta or comminuted proximal humerus fracture. Pdf international variation in shoulder arthroplasty. The animation shows a reverse total shoulder replacement for rotator cuff disease using a reverse shoulder replacement system. Reverse shoulder replacement is commonly performed and is generally a safe procedure. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion.
Reverse shoulder arthroplasty rsa has gained popularity in the treatment of proximal humeral fractures phfs, especially in elderly patients. The reverse total shoulder prosthesis early attempts of hemiarthroplasty or bipolar arthroplasty to treat cases of rotator cuff tear arthropathy were unable to consistently alleviate pain and restore function. These primarily include degenerative and incapacitating conditions with irreparable rotator cuff and loss of the normal biomechanical coupling of the shoulder. Long term functional outcome following reverse shoulder. In cta cases, common causes for failure are loss of the figure 4. Some surgeons recommend a superior approach when open surgery is used for rotator cuff repair, while others prefer an anterior deltopectoral approach, which saves the deltoid. Reverse total shoulder replacement with univers revers. Malunion or nonunion of the tuberosities does not affect the functional result after reverse total shoulder arthroplasty as much as it. Problems unique to the reverse total shoulder replacement. The use of the pressfit component allowed for easier structural grafting of the glenoid, and the constrained.
Everse shoulder arthroplasty gonzalo samitier md, phd hfhs sports medicine fellow 2. The role of subscapularis repair in reverse total shoulder. Reverse total shoulder arthroplasty rtsa is known to be an effective surgical procedure for massive irreparable rotator cuff tears, comminuted proximal humerus fractures, and revision shoulder. Pdf how reverse shoulder arthroplasty works researchgate. Rehabilitation guidelines for shoulder arthroplasty and reverse ball and socket arthroplasty the anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee. The purpose of this study was to investigate the use of rsa implants for acute phfs and risk of revision, as well as risk factors for revision. Patients with a reverse total shoulder arthroplasty do not dislocate with the arm in abduction and external rotation.
Reverse total shoulder replacement rehabilitation guidelines. The full text of this article is available in pdf format. Pdf reverse total shoulder arthroplasty techniques and. Postoperative rehabilitation instructions reverse total.
Reverse total shoulder arthroplasty is indicated for the treatment of conditions that cannot be treated with conventional arthroplasty or other procedures. Reverse shoulder arthroplasty for acute fractures in the elderly. Indications for reverse total shoulder arthroplasty rtsa have expanded over the past decade. The intent of this protocol is to provide the physical therapist with a guidelinetreatment protocol for the postoperative rehabilitation management for a patient who has undergone a reverse total. Anterior posterior radiography of a right shoulder a and an illustration of a left shoulder b after reverse total shoulder arthroplasty. Early followup reveals high complication rate with. Reverse total shoulder arthroplasty rtsa is a procedure that can reliably. Reverse shoulder arthroplasty rsa has seen a significant increase in. The most effective way to improve treatment methods is to combine basic.
Reverse shoulder arthroplasty for the treatment of proximal. Reverse or inverse total shoulder arthroplasty rtsa is designed specifically for the treatment of glenohumeral gh arthritis when it is associated with irreparable rotator cuff damage, complex fractures as well as for a revision of a previously failed conventional total shoulder arthroplasty tsa in which the rotator cuff tendons are deficient. The shoulder has a range of motion greater than any other joint in the entire body, except when things go wrong. Bas p hartel, tjarco dw alta, miguel e sewnath, w jaap willems submitted for journal publication 91 chapter 6 kinematic and clinical evaluation of shoulder function after. Reverse shoulder arthroplasty includes 2 glenoid components. Gartsmanauthor of the wellreceived shoulder arthroscopyand t. While the shoulder implant results in a more stable joint, it comes with a greater chance of.
Shoulder joint replacement surgery also called shoulder arthroplasty can effectively ease pain from shoulder arthritis. A conventional shoulder replacement device mimics the normal anatomy of the shoulder. A conventional replacement device also uses the rotator cuff muscles to function properly. On the other hand, tobacco use negatively impacts the outcomes following rtsa by nearly doubling the overall complication rate. In the reverse prosthesis the shoulder joint is still replaced with parts or components made out of metal and plastic figure 3. The humeral component replaces the head of the upper arm bone, while the glenoid component replaces the socket the glenoid depression. Age, injury and arthritis can spell problems that begin with pain and end with shoulder and arm immobility. Prevalence of primary and revision total hip and knee arthroplasty in the. A practical approach pdf this masterful book from top experts provides clinical insights on reverse shoulder arthroplasty gleaned from handson refinement of shoulder replacement techniques. Reverse total shoulder arthroplasty and workrelated outcomes. Reverse total shoulder arthroplasty protocol phase 1. The reverse, or inverse total shoulder arthroplasty is usually used for patients with arthritis who have an associated irreparable rotator cuff tear, complex fractures, or for the revision of a previously failed conventional arthroplasty in which the rotator cuff tendons are deficientabsent.
Structural bone grafting on the glenoid side is successful at managing large defects, producing similar or better clinical outcomes compared with patients without bone loss. What is a successful outcome following reverse total. Since the promotion of the principles of the reverse shoulder prosthesis in the 80 by. Reverse total shoulder arthroplasty clinical practice guidelines progression is time and criterionbased, dependent on soft tissue healing, patient demographics and clinician evaluation. Total reverse shoulder replacement is now a very common surgical procedure that. Utilization of reverse total shoulder arthroplasty in the. Ninetyday readmissions following reverse total shoulder arthroplasty.
Reverse shoulder arthroplasty biomechanics, clinical. The first reverse shoulder arthroplasty case was reported in the database in 2005, weber noted, and the procedure represented 0. Rsa has been used successfully in patients with rotator cuff arthropathy, complex proximal humerus fractures and nonunions, and for revisions of failed conventional shoulder arthroplasties 1. Contact ohio state sports medicine at 6142932385 if questions arise. Rocking horse phenomenon rocking horse phenomenon 5. Therefore, the current advice in this situation is to combine the reverse prosthesis. Reverse total shoulder arthroplasty joint replacement procedure where the ball and socket articulations of the glenohumeral joint are reversed received fda approval for use in the us in 2004 3. In addition, most of the designs on the market make it possible to combine. Reverse shoulder arthroplasty can therefore be read either from start to finish, allowing orthopedic surgeons to appreciate the various perspectives offered, or by selecting specific topics of interest much like a howto manual of either a particular device design or the treatment of a specific pathology. Reverse shoulder arthroplasty rsa may be indicated in displaced. Reverse shoulder arthroplasty for the treatment of complex fractures of the proximal part of the humerus appears to have good results at short and intermediateterm followup. Loss of its integrity results in varying levels of functional loss.
Reverse total shoulder arthroplasty robert rolf md and tim elser pt, dhsc, atc, ocs indications reverse total shoulder replacement is indicated for use in grossly rotator cuff deficient joints with severe arthropathy, or for use when a previous joint replacement has failed with a grossly rotator cuff deficient joint. Conventional shoulder replacement surgery replaces damaged joint surfaces with artificial parts prostheses. The reverse shoulder arthroplasty is considered to be one of the most significant technological advancements in shoulder reconstructive surgery over the past 30 years. Reverse total shoulder arthroplasty rsa is often used in more complex shoulder derangement with coexistent rotator cuff deficiencies. Long term functional outcome following reverse shoulder arthroplasty in the elderly.
Low risk of revision after reverse shoulder arthroplasty. Pdf the reverse total shoulder arthroplasty was introduced to treat the rotator. Reverse shoulder arthroplasty the shoulder is a ball and socket joint that enables you to raise, twist, bend and move your arms forward, to the sides and behind you. Journal of shoulder and elbow surgery american shoulder and elbow surgeons. Pdf the reported rate of complications of reverse shoulder arthroplasty rsa seems to be higher than the complication rate of anatomical. Reverse total shoulder arthroplasty is a very interesting new addition to what we do in shoulder replacement just as if the patient has had a knee replacement, which people are familiar with, or a hip replacement. The third indication for reverse shoulder arthroplasty is revision of previously failed arthroplasty. In a standard shoulder replacement, the ball portion of the shoulder the humeral head is replaced by a metal ball and the socket is replaced by a plastic piece figure 2. Longterm outcomes of reverse total shoulder arthroplasty. Deltoid function and periscapular strength become primary sources of shoulder mobility and stability.
It is not intended to be a substitute for special instructions from. Rehabilitation guidelines for shoulder arthroplasty and. Is it feasible to merge data from national shoulder registries. The rotator cuff is a group of muscles that are responsible for. The arthrex univers revers shoulder system provides the orthopaedic surgeon the option to implant a traditional grammont style configuration which follows the principles of a constrained environment that medializes the center of rotation and lengthens the deltoid, resulting in increased torque with forward flexion. Shoulder joint replacement surgery also called shoulder arthroplasty is a great treatment for many people with shoulder pain from arthritis. Reverse total shoulder arthroplasty rtsa is designed specifically for the treatment of glenohumeral shoulder arthritis when it is associated with irreparable rotator cuff damage, complex fractures as well as for a revision of a previously failed conventional total shoulder arthroplasty. Microsoft word reverse total shoulder arthroplasty 2012.
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