Rehabilitation protocol for reverse shoulder arthroplasty. Rehabilitation guidelines for shoulder arthroplasty and reverse. Current concepts, results, and component wear analysis find, read. Department of rehabilitation services reverse total shoulder. Shoulder joint replacement surgery also called shoulder arthroplasty can effectively ease pain from shoulder arthritis. The role of subscapularis repair in reverse total shoulder.
The purpose of this prospective study was to directly compare 2. Reverse total shoulder arthroplasty is indicated for the treatment of conditions that cannot be treated with conventional arthroplasty or other procedures. If the risks associated with the procedure are determined to be acceptable for the patients expected benefit, the follow technique for reverse total shoulder arthroplasty can be used. Pdf biomechanic principles of reverse shoulder prosthesis. The technique was devised to provide a solution to the problem of how to reduce pain and restore mobility with a stable rotational center. Pdf reverse total shoulder arthroplasty techniques 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 shoulder arthroplasty rtsa. Focusing exclusively on reverse shoulder arthroplasty rsa techniques and devices, this plentifully illustrated text covers all aspects of this important and innovative treatment for shoulder pain and dysfunction. This is because the articular surface of the round.
The intent of this protocol is to provide the therapist with a guideline for the postoperative rehabilitation course of a patient that has undergone a total shoulder arthroplasty tsa or hemiarthroplasty humeral. 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. Reahabilitation following reverse total shoulder arthropoplasty. The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Retrospective case series evaluating patients undergoing reverse shoulder arthroplasty with at least two years of clinical followup.
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 adjunctive exercises. Everse shoulder arthroplasty gonzalo samitier md, phd hfhs sports medicine fellow 2. Rehabilitation guidelines for shoulder arthroplasty and.
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. 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. Pdf on jan 1, 2010, d nam and others published reverse total shoulder arthroplasty. Rocking horse phenomenon rocking horse phenomenon 5. Your shoulder is a ball and sockettype joint made up of two main parts. The rotator cuff is a group of muscles that are responsible for. Reverse total shoulder replacement is a complex procedure and is warranted by certain conditions. Since the introduction of reverse total shoulder arthroplasty rtsa in 1987 in europe and 2004 in the united states, the number of rtsas. The book begins with a history of rsa followed by a thorough overview of the basic science and biomechanics of the shoulder. Reverse total shoulder arthroplasty rsa was designed to provide pain relief and improve shoulder function in patients with severe rotator cuff tear arthropathy. Before suggesting the operation, your doctor will have considered that the benefits of having the operation outweigh any disadvantages.
Contact ohio state sports medicine at 6142932385 if questions arise. Clinical experience with total arthroplasty and hemiarthroplasty of the shoulder using the neer prosthesis. The head of the upper arm bone humerus is the ball and a circular depression glenoid in the shoulder bone scapula is the socket. In his original paper describing hemiarthroplasty, five of 12 patients had good or excellent range of motion, and one of 12 had pain with use 1. Reverse total shoulder arthroplasty what is reverse total shoulder arthroplasy rtsa. Reverse total shoulder arthroplasty protocol phase 1. Pdf since the introduction of reverse total shoulder arthroplasty rtsa in 1987 in europe and 2004 in the united states, the number of. Bradley edwards, md, and gilles walch, md investigation performed at the department of orthopaedic surgery, clinique sainte anne lumiere, lyon, france.
Reverse total shoulder arthroplasty rtsa was designed to provide pain relief, improve functional results, and reduce the risk of implant failure in patients with a painful rotator cuffdeficient shoulder. The semiconstrained reverse shoulder prosthesis, designed by grammont in the. Complications in reverse shoulder arthroplasty ncbi. The reverse shoulder arthroplasty is considered to be one of the most significant technological advancements in shoulder reconstructive surgery over the past 30 years. Total shoulder arthroplasty hemiarthroplasty protocol. The purpose of the present article is to help orthopedic surgeons better understand the function and performance of reverse total shoulder arthroplasty, and also to help them perform the. Maintain stable prosthesis minimize pain and inflammatory response.
The reported rate of complications of reverse shoulder arthroplasty rsa seems to be higher than the complication rate of anatomical total. 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. The patient is placed into the beachchair position and the arm is prepped and draped free in standard fashion. A conventional shoulder replacement device mimics the normal anatomy of the shoulder. Reverse total shoulder arthroplasty can be performed using general. Although reverse shoulder arthroplasty provides excellent clinical results in appropriately selected patients, loss of external and internal rotation may occur. Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss. 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. 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. Mar 06, 2017 the animation shows a reverse total shoulder replacement for rotator cuff disease using a reverse shoulder replacement system.
Pdf reverse total shoulder arthroplasty researchgate. Initiate pain free rotator cuff and deltoid strengthening. The animation shows a reverse total shoulder replacement for rotator cuff disease using a reverse shoulder replacement system. This stemmed design was made from vitallium with fenestrations for bone intrusion.
The patient version of the shoulder arthroplasty gives you an idea of what to expect from surgery until discharge. Historically, total shoulder arthroplasty tsa and reverse shoulder arthroplasty rsa have shared a common international classification of diseases icd code, therefore, data on utilization of the rsa has not been obtainable. In the reverse ball and socket arthroplasty the joint is actually flipped upside down such that the ball is now attached to the shoulder blade and the tee is attached. Current designs and trends in reverse shoulder arthroplasty. Patient is able to maintain painfree shoulder arom typically 80120 of elevation, with functional er of about 30 2. Orthopedics reverse shoulder arthroplasty may be performed using components that medialize or lateralize the center of rotation. 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.
Reverse shoulder arthroplasty for the treatment of proximal. Understanding the biomechanics and rationale behind the surgical technique and its relationship to implant design is essential. In 1991, the humeral component was changed to a stemmed metallic implant and the glenoid component was changed to a hemispherical design that positioned the glenohumeral cen. Each case can be very different depending on the goals of the patient, the age of the. Patient demonstrates proper shoulder mechanics references bourdreau s, bourdreau e, higgins ld, and wilcox rb. Reverse shoulder arthroplasty rsa is one of the main recent evolutions in shoulder surgery and it has generated a great deal of enthusiasm in a relatively short period of time. Physical therapy management of reverse total shoulder arthro. Reverse total shoulder arthroplasty is becoming a very popular surgical technique used to alleviate pain and dysfunction as a result of end stage rotator cuff arthropathy, complete rotator cuff tear, proximal humerus fracture, previous failed shoulder arthroplasty, tumor resection, as well as glenohumeral instability. Reverse shoulder arthroplasty as treatment for comminuted. The reverse total shoulder arthroplasty was introduced to treat the rotator cuffdeficient shoulder. When neer introduced his proximal humerus prosthesis in the 1950s, there was renewed interest in shoulder arthroplasty.
Department of rehabilitation services reverse total. Since its introduction, an improved understanding of the biomechanics of rotator cuff deficiency and reverse shoulder arthroplasty has facilitated the development of modern reverse arthroplasty designs. The shoulder has a range of motion greater than any other joint in the entire body, except when things go wrong. Rehabilitation protocol for reverse shoulder arthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a reverse shoulder arthroplasty. Medialized versus lateralized center of rotation in. 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. Due to the biomechanics of a reverse arthroplasty there is a higher risk of shoulder dislocation following a reverse shoulder arthroplasty versus a traditional shoulder replacement. Reverse total shoulder replacement with univers revers. The head of the upper arm bone humerus is the ball and a circular depression glenoid in the shoulder bone scapula is. Controversy surrounds the role of the subscapularis ssc in reverse shoulder arthroplasty rtsa. Reverse shoulder arthroplasty rsa is a common surgery for degenerative joint disease with deficient rotator cuff. On the top of the long bone humerus is a round head which fits snugly into a cup shaped space glenoid in the. Reverse total shoulder replacement johns hopkins shoulder. Effect of humeral component version on outcomes in reverse.
Malunion or nonunion of the tuberosities does not affect the functional result after reverse total shoulder arthroplasty as much as it. Mcclelland jr, charles bessiere, charlesedouard thelu, adam p. Due to the biomechanics of a reverse arthroplasty there is a higher risk of shoulder dislocation following a reverse shoulder arthroplasty versus. Revision reverse shoulder arthroplasty in failed shoulder. 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.
This is because the articular surface of the round humeral head is approximately four times greater than. The reverse shoulder arthroplasty emerged as a potential solution for those patients who could not be managed effectively with a conventional total shoulder arthroplasty. Traditional surgical options for these patients were limited and functional results were suboptimal and at times catastrophic. Most people experience improved shoulder function after this surgery. Reverse shoulder replacement is commonly performed and is generally a safe procedure. Specific interventions should be based on the needs of the individual and should consider exam findings. 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. It is by no means intended to be a substitute for a physical. No matter which postsurgical protocol is followed, protecting the new joint is of particular importance after a reverse shoulder arthroplasty.
Reverse total shoulder arthroplasty protocol weeks allow healing of soft tissue, monitor neurovascular status independent with adls with modifications to protect joint replacement. The role of subscapularis repair in reverse total shoulder arthroplasty. These primarily include degenerative and incapacitating conditions with irreparable rotator cuff and loss. Reverse total shoulder arthroplasty rsa was first described by grammont et al. 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. 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. It is not intended to be a substitute for special instructions from. Following your total shoulder surgery 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. Age, injury and arthritis can spell problems that begin with pain and end with shoulder and arm immobility. Analysis of factors affecting the long term results of total shoulder arthroplasty in inflammatory arthritis. Grammont revolutionized the design by medializing and distalizing the center of. While hemiarthroplasty is also an unreliable treatment for rotator cuff tear arthropathy, reverse shoulder arthroplasty. While this procedure has been known to reduce pain, improve strength and increase range of motion in.
Problems, complications, reoperations, and revisions in reverse total. Jul 05, 2011 reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in patients who were not appropriate for tendon transfer reconstructions. The reverse shoulder replacement has the ball of the shoulder joint where the socket should be and the socket where the ball usually is in normal anatomy. Factors affecting fixation of the glenoid component of a reverse total. 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. 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.
When arthritis affects the shoulder it can cause the lining of these joint surfaces to. Utilization of reverse total shoulder arthroplasty in the. Reverse total shoulder arthroplastybiomechanics and. It involved reversing the polarity of the ball and the socket by placing a ball component at the glenoid and an articular socket at the proximal humerus. In a reverse total shoulder replacement, the socket and metal ball are switched. Sling is to be worn full time outside of the home and sleeping for 23 weeks, prn in the home may. A patients guide to reverse shoulder arthroplasty introduction. 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. Prosthesis design and placement in reverse total shoulder. Reverse shoulder arthroplasty biomechanics, clinical. South florida orthopaedics and sports medicine 29,733 views. The first modern shoulder arthroplasty with an anatomic shape, including medial and posterior offset, was implanted by frederick krueger on the 12th of december 1950 72. 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.
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