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

2. Anatomy

3. Historical Perspective 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 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 Reverse HemiarthroplastyDebridement

27. Patient with Rotator Cuff Tear Limited Arthropathy Limited Arthropathy Manage the RCT Severe Arthritis No Superior Migration Hemiarthroplasty (conventional or CTA type) (conventional or CTA type) Superior Migration Reverse TSA

28. Thank You Thank You