Pdf the reverse total shoulder arthroplasty was introduced to treat the rotator. Reverse total shoulder arthroplasty rtsa is a procedure that can reliably. 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. Reverse shoulder arthroplasty includes 2 glenoid components. This is because the articular surface of the round humeral head is approximately four times greater than. Rocking horse phenomenon rocking horse phenomenon 5. Patients with a reverse total shoulder arthroplasty do not dislocate with the arm in abduction and external rotation. 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 cta cases, common causes for failure are loss of the figure 4. 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. A conventional replacement device also uses the rotator cuff muscles to function properly. 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 can be an efficacious salvage procedure in the management of failed arthroplasty due to rotator cuffrelated instability or bone defects, or both. The shoulder has a range of motion greater than any other joint in the entire body, except when things go wrong.
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. Age, injury and arthritis can spell problems that begin with pain and end with shoulder and arm immobility. But, certain patients are not candidates for joint replacement of the shoulder because they lack the muscle function necessary to stabilize the joint. Reverse total shoulder arthroplasty what is reverse total shoulder arthroplasy rtsa. Current outcomes following reverse total shoulder arthroplasty. Anterior posterior radiography of a right shoulder a and an illustration of a left shoulder b after reverse total shoulder arthroplasty. Ninetyday readmissions following reverse total shoulder arthroplasty. Shoulder joint replacement surgery also called shoulder arthroplasty is a great treatment for many people with shoulder pain from arthritis. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion. Reverse total shoulder arthroplasty and workrelated outcomes. Since the promotion of the principles of the reverse shoulder prosthesis in the 80 by. 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. We previously reported early outcomes of a cohort of patients treated with a grammontstyle rtsa.
The full text of this article is available in pdf format. Reverse total shoulder replacement with univers revers. Reverse shoulder arthroplasty rsa may be indicated in displaced. Journal of shoulder and elbow surgery american shoulder and elbow surgeons. The indication for reverse shoulder arthroplasty rsa is most commonly rotator cuff disease in association with glenohumeral arthritis. There has been serious concern regarding the longevity and durability of outcomes of reverse total shoulder arthroplasty rtsa in younger patients.
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 third indication for reverse shoulder arthroplasty is revision of previously failed arthroplasty. Deltoid function and periscapular strength become primary sources of shoulder mobility and stability. Long term functional outcome following reverse shoulder. Early followup reveals high complication rate with. Total reverse shoulder replacement is now a very common surgical procedure that. 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. Problems unique to the reverse total shoulder replacement.
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. The most effective way to improve treatment methods is to combine basic. The use of the pressfit component allowed for easier structural grafting of the glenoid, and the constrained. Pdf complications in reverse shoulder arthroplasty researchgate.
Pdf international variation in shoulder arthroplasty. Functional outcome of hemiarthroplasty compared with reverse total shoulder arthroplasty in the treatment of rotator cuff tear arthropathy. Each case can be very different depending on the goals of the patient, the age of the. Bradley edwards provide stepbystep details for each category of. Gartsmanauthor of the wellreceived shoulder arthroscopyand t. Reverse shoulder arthroplasty rsa may be indicated in displaced proximal. 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. 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. Postoperative rehabilitation instructions reverse total. 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. Conventional shoulder replacement surgery replaces damaged joint surfaces with artificial parts prostheses.
The animation shows a reverse total shoulder replacement for rotator cuff disease using a reverse shoulder replacement system. 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. In the reverse prosthesis the shoulder joint is still replaced with parts or components made out of metal and plastic figure 3. Before suggesting the operation, your doctor will have considered that the benefits of having the operation outweigh any disadvantages. Utilization of reverse total shoulder arthroplasty in the. Reverse shoulder replacement is commonly performed and is generally a safe procedure. Reverse shoulder arthroplasty rsa has seen a significant increase in. Malunion or nonunion of the tuberosities does not affect the functional result after reverse total shoulder arthroplasty as much as it. On the other hand, tobacco use negatively impacts the outcomes following rtsa by nearly doubling the overall complication rate.
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. Reverse shoulder replacement has become increasingly popular for people with serious shoulder pain, immobility and rotator cuff injuries. A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. Despite the increasing numbers of reverse total shoulder arthroplasty rtsa procedures, the longterm results have been rarely reported. Longterm outcomes of reverse total shoulder arthroplasty. Prevalence and projections of total shoulder and elbow arthroplasty in the united states to 2015. 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. Rehabilitation protocol for reverse shoulder arthroplasty. 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.
Pdf reverse total shoulder arthroplasty techniques and. The reverse total shoulder arthroplasty was introduced to treat the rotator. Long term functional outcome following reverse shoulder arthroplasty in the elderly. Typically these patients have had a hemiarthroplasty placed for cta or comminuted proximal humerus fracture. Reverse shoulder arthroplasty for acute fractures in the elderly. 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. Department of rehabilitation services reverse total. 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. Reverse shoulder arthroplasty rsa has gained popularity in the treatment of proximal humeral fractures phfs, especially in elderly patients. The purpose of this study was to evaluate the outcomes after a minimum of 10 years, and to document prosthetic.
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. Prevalence of primary and revision total hip and knee arthroplasty in the. 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. Everse shoulder arthroplasty gonzalo samitier md, phd hfhs sports medicine fellow 2. Clinical results of revision shoulder arthroplasty using. Contact ohio state sports medicine at 6142932385 if questions arise. 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.
What is a successful outcome following reverse total. The humeral component replaces the head of the upper arm bone, while the glenoid component replaces the socket the glenoid depression. Pdf how reverse shoulder arthroplasty works researchgate. Reverse shoulder arthroplasty for the treatment of proximal. The role of subscapularis repair in reverse total shoulder. Reverse total shoulder arthroplasty is indicated for the treatment of conditions that cannot be treated with conventional arthroplasty or other procedures. Therefore, the current advice in this situation is to combine the reverse prosthesis. In addition, most of the designs on the market make it possible to combine. Shoulder joint replacement surgery also called shoulder arthroplasty can effectively ease pain from shoulder arthritis. Reverse total shoulder arthroplasty clinical practice guidelines progression is time and criterionbased, dependent on soft tissue healing, patient demographics and clinician evaluation. Reverse total shoulder arthroplasty protocol phase 1. 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. 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. Is it feasible to merge data from national shoulder registries.
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. 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. 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. Reverse shoulder arthroplasty biomechanics, clinical. Indications for reverse total shoulder arthroplasty rtsa have expanded over the past decade.
Loss of its integrity results in varying levels of functional loss. Low risk of revision after reverse shoulder arthroplasty. 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. These primarily include degenerative and incapacitating conditions with irreparable rotator cuff and loss of the normal biomechanical coupling of the shoulder.
Reverse total shoulder arthroplasty rsa is often used in more complex shoulder derangement with coexistent rotator cuff deficiencies. The rotator cuff is a group of muscles that are responsible for. 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. While the shoulder implant results in a more stable joint, it comes with a greater chance of.
Pdf the reported rate of complications of reverse shoulder arthroplasty rsa seems to be higher than the complication rate of anatomical. It is not intended to be a substitute for special instructions from. Reverse total shoulder replacement rehabilitation guidelines. The first reverse shoulder arthroplasty case was reported in the database in 2005, weber noted, and the procedure represented 0. Microsoft word reverse total shoulder arthroplasty 2012. Reverse shoulder arthroplasty for the treatment of. 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. A conventional shoulder replacement device mimics the normal anatomy of the shoulder. Reverse total shoulder arthroplasty the reverse, or inverse, total shoulder arthroplasty rtsa.
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