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- Reverse total shoulder arthroplasty
- March Book Reviews | Journal of Orthopaedic & Sports Physical Therapy
About this Item Language: English. Brand new Book. State-of-the art techniques for shoulder replacement surgeryShoulder Arthroplasty: Complex Issues in the Primary and Revision Setting assembles the clinical knowledge of leading orthopedic surgeons treating patients with arthritic shoulders. Features:Comprehensive discussion addressing everything from the latest techniques for arthroplasty to alternatives to total shoulder replacement Recommendations about how to avoid and manage common complications including infection, nonunion, malunion, instability, aseptic loosening, and soft tissue complications such as rotator cuff tears, impingement syndromes, and lesions Important coverage on the treatment of young arthritic patientsThis book is an essential reference for orthopedic surgeons, general surgeons, and residents in these specialties.
About this title Synopsis: State-of-the art techniques for shoulder replacement surgery Shoulder Arthroplasty: Complex Issues in the Primary and Revision Setting assembles the clinical knowledge of leading orthopedic surgeons treating patients with arthritic shoulders. Features: Comprehensive discussion addressing everything from the latest techniques for arthroplasty to alternatives to total shoulder replacement Recommendations about how to avoid and manage common complications including infection, nonunion, malunion, instability, aseptic loosening, and soft tissue complications such as rotator cuff tears, impingement syndromes, and lesions Important coverage on the treatment of young arthritic patients This book is an essential reference for orthopedic surgeons, general surgeons, and residents in these specialties.
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Most of our titles are dispatched within 2 business days of your order. Apart from publishers, distributors and wholesalers, we even list and supply books from other retailers! Although mild deltoid dysfunction may be tolerated by patients who can experience pain relief from the procedure, it is important for patients to understand that their ROM and function may not improve.
Patients undergoing RTSA should be aware of its high rate of intra-operative and post-operative complications. There is also concern about clinical deterioration at approximately ten years after implantation of the Grammont-type prostheses. Male sex, depression, total number of medical comorbidities, and receipt of workers compensation also correlated with little post-operative improvement. Rotator cuff tear arthropathy is one of the most reliable indications for RTSA. Accordingly, in a study of patients followed for a mean of 4.
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- Evolving trends in reverse shoulder arthroplasty.
At a mean of 4. Werner et al 30 retrospectively reviewed the results of 58 consecutive patients mean age 68 years who had undergone a Grammont-type RTSA. They reported significant improvements in patient-reported outcomes i. Frankle et al 29 reported results of 60 patients mean age 71 years with 60 rotator cuff tear arthropathies treated with RTSA who were followed for a minimum of two years. Recently, a systematic review with meta-analysis and meta-regression reported that patients with massive, irreparable rotator cuff tears without OA have a high likelihood of achieving a painless shoulder and functional improvements after RTSA.
Boileau et al 27 found that RTSA improved function for patients with pseudoparalysis and those with rotator cuff-deficient shoulders after failure of previous rotator cuff surgery, but results were inferior to those of primary RTSA for patients with massive rotator cuff tears or rotator cuff tear arthropathy. HA was traditionally the treatment of choice for three- and four-part proximal humerus fractures. Several studies have reported favourable results of RTSA to treat proximal humeral fractures. A recent meta-analysis showed that RTSA may produce more favourable clinical outcomes than HA for treating complex proximal humeral fractures.
Several studies have cautioned that RTSA may not be the optimal treatment for patients with acute proximal humerus fractures. Cazeneuve and Cristofari 55 and Bufquin et al 41 showed various post-operative radiographic findings in patients with acute proximal humerus fractures treated with RTSA, and they cautioned that long-term results are required before RTSA can be recommended as a routine procedure for complex fractures of the proximal humerus in the elderly.
Surgical options to address malunited proximal humerus fractures are determined largely by the existing deformity 56 and can be categorized broadly as humeral head-preserving techniques e. Studies with short-term follow-up have reported high rates of patient satisfaction with RTSA for improving ROM, treating malunited proximal humerus fracture and reducing pain.
Before surgery, patients should be informed that active external rotation might not be restored after RTSA, particularly if an osteotomy of the greater tuberosity is performed. Another approach to patients with painful, malunited proximal humeral fractures is to leave the tuberosities in place and insert the RTSA into the existing anatomy.
Willis et al 59 did not perform a tuberosity osteotomy when placing the RTSA and recommended using the largest possible glenosphere to tension the soft tissue and prevent bony impingement. Raiss et al 61 reported on 42 patients treated with RTSA for post-traumatic sequelae of the proximal part of the humerus with malunion of the tuberosities. Complications were one intra-operative humeral shaft fracture, one traumatic dislocation, one periprosthetic humeral fracture and one aseptic loosening of the humeral and glenoid components.
The authors concluded that RTSA is a good treatment option for type-4 proximal humeral fracture sequelae that cannot be treated with anatomical TSA. In a study at the same institution, the use of RTSA for the treatment of nonunion of the surgical neck of the proximal part of the humerus type-3 fracture sequelae produced improvement in functional outcome but a high complication rate. Therefore, the authors recommended that the tuberosities and the attached rotator cuff should be preserved if possible to reduce the risk of dislocation. The most commonly used classification is that of Walch et al: 65 type A2, central bone loss; type B2, posterior bone loss; and type C, severe retroversion of the glenoid Fig.
Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty ; Although glenoid bone grafting has been recommended for type-B2 and type-C glenoid wear, it has been shown that use of RTSA without glenoid bone grafting can be successful for patients with severe glenoid bone loss.
Long-term follow-up studies are needed before RTSA can be recommended in patients with severe glenoid bone loss. Chronic locked glenohumeral dislocation presents many challenges caused by humeral and glenoid bone loss, concomitant soft-tissue contractures and rotator cuff lesions Fig. Outcomes were rated as excellent by ten patients, good by eight patients and fair by three patients. The use of RTSA for patients with rheumatoid arthritis has been studied by several authors. The options for revision surgery after primary shoulder arthroplasty i. HA, resurfacing arthroplasty or TSA are limited by the challenges of rotator cuff deficiency, glenoid bone loss and soft-tissue contractures.
The outcomes of RTSA for failed shoulder arthroplasty have been favourable. Patel et al 80 reported on 28 patients who underwent RTSA for treatment of a failed shoulder arthroplasty i. They reported significant improvements in all outcome measures, including ASES score, University of California Los Angeles score, SST score and the visual analogue scale, with an overall complication rate of Black et al 16 reported on 32 patients aged younger than 65 years treated with RTSA after failed shoulder arthroplasty.
Results were compared with those of a similar cohort of 33 patients who underwent primary RTSA. Post-operatively, when comparing primary to revision RTSA, the visual analogue scale and ASES scores were not significantly different, whereas the subjective shoulder value was significantly better for the primary group. Several shoulder reconstruction techniques have been reported for patients after wide resection of the proximal humerus and rotator cuff tendons for malignant bone tumours, including allograft, arthrodesis and shoulder arthroplasties.
Bonnevialle et al 82 reported on eight patients treated for malignant tumours of the proximal humerus with transarticular resection of the tumour and shoulder reconstruction with RTSA. They reported improvement in all outcome scores and concluded that RTSA is an acceptable option to preserve function after resection of a malignant tumour of the proximal humerus.
Wierks et al 89 reported 33 complications in 15 patients; the most frequent complications were neuropathy, intra-operative fracture and dislocation, with the primary cause for revision surgery being dislocation. Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty.
Reverse total shoulder arthroplasty
J Shoulder Elbow Surg ; Teusink et al 97 reported that instability of RTSA often occurs within six months after surgery, with half of cases occurring within three months. When dislocation occurred within three months, a surgical error was considered the most likely cause and closed reduction was typically unsuccessful. In a systematic review including primary and revision RTSA, Zumstein et al 92 reported a mean infection rate of 3.
A history of shoulder trauma or failed HA has also been shown in some studies to be a risk factor for infection. Although some authors have suggested an increased risk of baseplate loosening with scapular notching, 30 , - others have not found such a relationship. The rates of notching were not different but the severity of notching was less when using an eccentric glenosphere.
Other authors have reported a negligible rate of notching when using an inferior offset component. Heterotopic ossification after RTSA is a relatively common finding of unknown clinical importance.
They found that men had a higher rate of heterotopic ossification than women, and that heterotopic ossification was associated with worse post-operative ROM. It has been postulated to be caused by releases, traction on the triceps and more extensive exposure of the glenoid than is typically done in anatomical TSA. Scapular fractures are a well-recognized complication of RTSA, and they have been reported in 0.
RTSA has revolutionized the treatment of shoulder disorders that previously had no easy or acceptable solution. Patient satisfaction with RTSA can be high, and most patients experience pain relief and improved function. Although the short-term implant survival rate appears to be acceptable, the long-term results are unknown. RTSA is associated with a higher rate and more diverse spectrum of complications than is desirable.
March Book Reviews | Journal of Orthopaedic & Sports Physical Therapy
Download Citations Track Citations Add to favourites. References 1. Complications of total shoulder arthroplasty. J Bone Joint Surg [Am] ; Google Scholar 2. Failure of the glenoid component in anatomic total shoulder arthroplasty: A systematic review of the English-language literature between and Total shoulder arthroplasty with the Neer prosthesis: long-term results. Shoulder hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency. Concept study and realization of a new total shoulder prosthesis [in French]. Rhumatologie ; Google Scholar 6.
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- Complications in reverse shoulder arthroplasty | EFORT Open Reviews.
Grammont reverse prosthesis: design, rationale, and biomechanics. Acromial fractures and locations were noted to involve either the acromion body or scapular spine. Heterotopic bone located on the inferior glenoid was identified and recorded. Humeral bone loss and reverse arthroplasty 3 Surgical technique Results Patients were evaluated preoperatively for the possibility of subclinical infection with the use of complete blood count, C-reactive protein level, and erythrocyte sedimentation rate.
The operative technique consisted of positioning the patient in a semi-Fowler position with the head secured and the arm draped free.