The success of rtsa in improving function in the absence of a functioning rotator cuff has led to a broad range of applications, including massive rotator cuff tear, failed hemi and anatomic total shoulder arthroplasty tsa, fractures and their sequelae, and tumor reconstruction. Management of complications can be challenging and the nuances of treatment are still being elucidated. The head of the upper arm bone humerus is the ball and a circular depression glenoid in the shoulder bone scapula is the socket. When arthritis affects the shoulder it can cause the lining of these joint surfaces to. A reverse total shoulder arthroplasty rtsa is usually chosen when the patient presents with rotator cuff arthropathy, failed shoulder arthroplasty, multiple failed rotator cuff repairs with poor function and anterosuperior instability, or malunion of the tuberosity after fracture. Mar 30, 2011 the anterosuperior approach used for reverse shoulder arthroplasty is an intermediate between the transacromial approach originally proposed by paul grammont and the anterosuperior approach described by d. Reverse shoulder replacement uw orthopaedics and sports. 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. Reverse shoulder arthroplasty biomechanics, clinical. Reverse shoulder arthroplasty for chronic dislocation phase i. Background reverse shoulder arthroplasty rsa shows a growing number of implantations and is a valuable option to improve shoulder function and decrease pain.
Reverse total shoulder arthroplasty and workrelated outcomes. Your shoulder is a ball and sockettype joint made up of two main parts. Rehabilitation protocol for reverse shoulder arthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a reverse shoulder arthroplasty. Specific interventions should be based on the needs of the individual and should consider exam findings. Rocking horse phenomenon rocking horse phenomenon 5. We are to deduce not only the early functional outcomes and complications of cementless rtsa during the learning curve period but also complicationbased, and operation timebased learning curve of rtsa.
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 replacement is a complex procedure and is warranted by certain conditions. The rotator cuff is a group of muscles that are responsible for. Reverse total shoulder replacement sports and ortho. Total shoulder arthroplasty tsa is indicated for patients with glenohumeral arthritis. Clinical outcomes and complications of cementless reverse. Recent journal of shoulder and elbow surgery articles elsevier. This procedure is specifically designed for the treatment of glenohumeral gh joint arthritis or complex fractures, when associated with irreparable rotator cuff rc damage or in the presence of rc arthropathy. Rehabilitation protocol for reverse shoulder arthroplasty. The use of reverse shoulder arthroplasty is becoming increasingly popular for the treatment of complex three and fourpart proximal humerus fractures in the elderly compared with the often unpredictable and poor outcomes provided by open reduction and internal fixation and by hemiarthroplasty. Recently published articles from journal of shoulder and elbow surgery. Revision of an unstable hemiarthroplasty or anatomical total shoulder. The biomechanics of reverse shoulder arthroplasty download. Each case can be very different depending on the goals of the patient, the age of the.
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. Initiate exercise program 3 times per day immediately. Mar 06, 2017 the animation shows a reverse total shoulder replacement for rotator cuff disease using a reverse shoulder replacement system. Reverse total shoulder arthroplasty for irreparable rotator. Revision strategies in reverse total shoulder arthroplasty. Everse shoulder arthroplasty gonzalo samitier md, phd hfhs sports medicine fellow 2. Rehabilitation following reverse shoulder arthroplasty. This site is like a library, use search box in the widget to get ebook. However, there is no consensus concerning the rehabilitation protocol following surgery.
Reverse total shoulder replacement with univers revers. Reverse shoulder arthroplasty an overview sciencedirect. 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. Mar 31, 2016 orthopedics the average retirement age is increasing, and the indications for reverse total shoulder arthroplasty rtsa are being broadened. Pdf management of complications after reverse shoulder. Reverse total shoulder arthroplasty techniques and pitfalls. Biomechanics of reverse total shoulder arthroplasty. Rehabilitation protocol for total shoulder arthroplasty and hemiarthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a total shoulder arthroplasty tsa and hemiarthroplasty. Protect the replacement 0 to 6 weeks slingimmobilizer should be worn at all times for 2 weeks then when sleeping and out in public.
Reverse shoulder arthroplasty for the treatment of proximal. Reverse shoulder arthroplasty for the treatment of three and fourpart fractures of the proximal humerus in the elderly. Shoulder arthroplasty denver shoulder surgery specialist aurora. A lot of people dont realize we do shoulder replacements. Reverse total shoulder arthroplasty rtsa is indicated for patients with glenohumeral arthritis and a poorly functioning rotator cuff. Pendulums may begin at 2 weeks after instruction by therapist. Reverse shoulder arthroplasty is becoming increasingly common because conventional total shoulder replacement may cause pain, loss of strength, simple or complex disabilities as well as limited motion, reducing general quality of life. Reverse or inverse total shoulder arthroplasty rtsa is becoming a widely accepted surgical intervention.
Failed reverse shoulder arthroplasty and recommendations for. 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. Reverse total shoulder replacement rehabilitation guidelines. 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. Management of complications after reverse shoulder arthroplasty. Jan 20, 2020 the most common complications warranting revision consideration in reverse shoulder arthroplasty rsa include instability and its associated causes. 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 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.
A conventional shoulder replacement device mimics the normal anatomy of the shoulder. Malunion or nonunion of the tuberosities does not affect the functional result after reverse total shoulder arthroplasty as much as it. Our hypothesis was that reverse total shoulder arthroplasty tsa yields better clinical results compared with open reduction and internal fixation orif using an angular stable plate. Reverse shoulder arthroplasty anders ekelund, 2009. Rehabilitation protocol for total shoulder arthroplasty and. 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. Slingimmobilizer should be worn at all times other than when showering. Reverse shoulder arthroplasty with and without latissimus and teres. Pdf rehabilitation following reverse shoulder arthroplasty. Reverse total shoulder replacement is a great option for patients who have arthritis in the shoulder as well as a rotator cuff tear. Click download or read online button to get the biomechanics of reverse shoulder arthroplasty book now. Pdf reverse total shoulder arthroplasty techniques and. Feb 17, 2015 reverse total shoulder replacement, final 1.
The major difference between a standard shoulder replacement and a reverse procedure is that in a reverse shoulder replacement the ball and socket parts of the shoulder joint switch sides. Rehabilitation following reverse total shoulder arthroplasty. Pain relief is predictable and the reconstruction is proving to be durable. The goal of a reverse prosthesis is to restore a painless, biomechanically valid joint. Reverse total shoulder arthroplasty rtsa has dramatically altered the field of shoulder reconstruction. The increased risk in reverse shoulder arthroplasty must be. The delphi trial is a randomized controlled trial comparing reverse tsa with orif for displaced proximal humeral fractures otaao types 11b2 and 11c2 in elderly patients 65 to 85.
In a reverse total shoulder replacement, the socket and metal ball are switched. Patients who have had a reverse total shoulder replacement are considered rotator cuff deficient emphasis will eventually be on a aarom and a high repetition, low weight free weight program address scapular malpositioning if indicated minimal to no pain during or after exercises, although fatigue is ok. Frederick matsen, uw medical center orthopedic surgeon, discusses a new and innovative shoulder replacement surgery featuring a reverse ballsocket technique that can lessen pain and improve function in shoulders with failed surgery or combined arthritis, rotator cuff tears and instability issues. Revision reverse shoulder arthroplasty elbow surgeon aurora. Department of rehabilitation services reverse total shoulder. Rates of scapular notching are significant, occurring in up to two thirds of patients within 2 years of reverse shoulder arthroplasty. Reverse shoulder replacement and postop exercises youtube. Reverse shoulder arthroplasty is superior to plate fixation. In this procedure, the humeral head and glenoid surface are replaced with prosthetic components. Current concepts of shoulder arthroplasty for radiologists. 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. Reverse shoulder arthroplasty for the management of proximal. Reverse total shoulder arthroplasty is an outstanding procedure for the treatment of older patients with a massive rotator cuff tear or failed cuff syndrome.
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