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

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→

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