shoulder arthroplasty kelton burbank, md ramsey rehab lecture series october 27, 2009
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Shoulder ArthroplastyShoulder Arthroplasty
Kelton Burbank, MDKelton Burbank, MD
Ramsey Rehab Lecture SeriesRamsey Rehab Lecture Series
October 27, 2009October 27, 2009
AnatomyAnatomy
Historical PerspectiveHistorical Perspective 1893 French Surgeon Pean had a platinum and 1893 French Surgeon Pean had a platinum and
rubber total joint fashioned by a local dentistrubber total joint fashioned by a local dentist Inserted into a 37 yo baker with TB ArthritisInserted into a 37 yo baker with TB Arthritis Removed 2 yrs later for recurrent InfectionRemoved 2 yrs later for recurrent Infection
Historical PerspectiveHistorical Perspective
1953 Neer replaced 1953 Neer replaced fx proximal humerusfx proximal humerus
1971 used TSA for 1971 used TSA for RA and OARA and OA
Initial Prosthesis Initial Prosthesis (Neer) had 3 sizes(Neer) had 3 sizes
PrevalencePrevalence
1990-1993 < 5000/yr Shoulder Arthroplasties 1990-1993 < 5000/yr Shoulder Arthroplasties 1998 - 15,266 procedures1998 - 15,266 procedures Compared to 540,000 Hip and Knee in 1998Compared to 540,000 Hip and Knee in 1998 2-3% of all Arthroplasties2-3% of all Arthroplasties
Clinical IndicationsClinical Indications
OsteoarthritisOsteoarthritis Inflammatory ArthritisInflammatory Arthritis OsteonecrosisOsteonecrosis Rotator Cuff Rotator Cuff
ArthropathyArthropathy FractureFracture TumorTumor
INDICATIONSINDICATIONS
GLENOHUMERAL JOINT ARTHRITIS GLENOHUMERAL JOINT ARTHRITIS RESULTING IN:RESULTING IN: PAINPAIN LOSS OF MOTIONLOSS OF MOTION LOSS OF FUNCTIONLOSS OF FUNCTION
OTHER TREATMENT OTHER TREATMENT OPTIONS OPTIONS
ACTIVITY MODIFICATIONACTIVITY MODIFICATION NSAIDS/TOPICAL ANALGESICSNSAIDS/TOPICAL ANALGESICS PT*PT*
USUALLY ELICITS PAINUSUALLY ELICITS PAIN INJECTIONSINJECTIONS
CORTISONECORTISONE HYALURONIC ACIDHYALURONIC ACID
ARTHROSCOPYARTHROSCOPY FUSIONFUSION
Other Options: FusionOther Options: Fusion
YoungYoung Heavy LaborerHeavy Laborer Poor function of Poor function of
Rotator Cuff and Rotator Cuff and DeltoidDeltoid
InfectionInfection Decreasing Decreasing
IndicationsIndications
ARTHROSCOPYARTHROSCOPY
Lavage/debridementLavage/debridement Capsular releaseCapsular release Removal of loose bodiesRemoval of loose bodies Biceps tenotomyBiceps tenotomy Distal clavicle excisionDistal clavicle excision Subacromial decompression*Subacromial decompression* Debridement of rotator cuff tearDebridement of rotator cuff tear
ArthroscopyArthroscopy
ArthroscopyArthroscopy
TYPES OF SHOULDER TYPES OF SHOULDER REPLACEMENTREPLACEMENT
RESURFACINGRESURFACING HEMIHEMI
REGULARREGULAR CTA HEADCTA HEAD
TOTALTOTAL REVERSEREVERSE
ResurfacingResurfacing
Young patientsYoung patients Preserve bonePreserve bone Glenoid?Glenoid?
HemiarthroplastyHemiarthroplasty
INDICATIONSINDICATIONS Uninvolved GlenoidUninvolved Glenoid
OsteonecrosisOsteonecrosis Proximal Humerus FxProximal Humerus Fx OsteoarthritisOsteoarthritis Rheumatoid Arthritis?Rheumatoid Arthritis?
Unstable forces on Unstable forces on GlenoidGlenoid Significant Rotator Cuff Significant Rotator Cuff
TearTear
HEMI:HEMI:Cuff Tear Arthropathy (CTA)Cuff Tear Arthropathy (CTA)
Large Rotator Cuff Large Rotator Cuff TearTear
Indicated for high Indicated for high riding stable humeral riding stable humeral headhead
No Anterior EscapeNo Anterior Escape ““Iatrogenesis Iatrogenesis
Imperfecta”Imperfecta”
Total Shoulder Total Shoulder ArthroplastyArthroplasty
Indication Indication Pain ReliefPain Relief
ContraindicationsContraindications Nerve deficitsNerve deficits Noncompliant ptsNoncompliant pts ? Infection? Infection Rotator cuff Rotator cuff
deficienciesdeficiencies
TOTAL SHOULDER TOTAL SHOULDER ARTHROPLASTYARTHROPLASTY
Complications TSAComplications TSA
Glenoid looseningGlenoid loosening Humeral looseningHumeral loosening Glenoid wear (hemi)Glenoid wear (hemi) InstabilityInstability Rotator cuff tearsRotator cuff tears Periprosthetic FxPeriprosthetic Fx InfectionInfection Nerve InjuriesNerve Injuries
REVERSE TSAREVERSE TSA
Biomechanical TheoryBiomechanical Theory
REVERSE TSAREVERSE TSA
Complication RateComplication Rate DurabilityDurability Revision?Revision?
DELTADELTA
↓
→
Post Operative RehabPost Operative Rehab
TSATSA Check range in ORCheck range in OR Start AAROM POD 1Start AAROM POD 1 Active ROM as Active ROM as
toleratedtolerated Protect Subscap 4-6 Protect Subscap 4-6
weeksweeks Strengthening at 4-6 Strengthening at 4-6
weeksweeks
Activities after TSAActivities after TSA
Decision Algorithm in Decision Algorithm in Rotator Cuff Tears with OARotator Cuff Tears with OA
ReverseReverse
HemiarthroplastyHemiarthroplastyDebridementDebridement
Decision Algorithm in Decision Algorithm in Rotator Cuff Tears with OARotator Cuff Tears with OA
Patient with Rotator Cuff TearPatient with Rotator Cuff Tear
Limited ArthropathyLimited ArthropathyManage the RCTManage the RCT
Severe ArthritisSevere Arthritis
No Superior MigrationNo Superior MigrationHemiarthroplastyHemiarthroplasty
(conventional or CTA type)(conventional or CTA type)
Superior MigrationSuperior MigrationReverse TSAReverse TSA
Thank YouThank You
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