Outcomes Following rTSA What our patients are teaching us! Patrick - - PowerPoint PPT Presentation

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Outcomes Following rTSA What our patients are teaching us! Patrick - - PowerPoint PPT Presentation

May 08, 2023 256 likes •707 views

Outcomes Following rTSA What our patients are teaching us! Patrick St. Pierre, M.D. Director, Shoulder and Elbow Service and Orthopedic Research DISCLOSURES The following rela.onships exist: 1. Royal.es and stock op.ons DJO Surgical Lippinco?,

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Outcomes Following rTSA What our patients are teaching us!

Patrick St. Pierre, M.D. Director, Shoulder and Elbow Service and Orthopedic Research

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DISCLOSURES

The following rela.onships exist:

  • 1. Royal.es and stock op.ons

DJO Surgical Lippinco?, Williams & Wilkins

  • 2. Consultant

DJO Surgical Cayenne (Zimmer-Biomet)

  • 3. Speaker Panels

DJO Surgical Cayenne (Zimmer-Biomet)

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Arthroplasty and in particular rTSA volumes increasing

Kim et al, 2011

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UTILIZATION

Hemiarthroplasty

  • 15%
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UTILIZATION

a TSA 5%

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UTILIZATION

r TSA 17%

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UTILIZATION

Revision 14%

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Indications for 
 Reverse Arthroplasty

  • Grossly deficient rotator cuff shoulder joint with

severe arthropathy

  • Failed joint replacement with a grossly deficient

rotator cuff shoulder joint

  • Displaced Proximal Humerus Fractures
  • Rheumatoid Arthritis
  • Massive Rotator Cuff Tears
  • OA with B2 glenoid and posterior wear - Walch
  • Glenoid bone deficiency
  • Elderly patients with Osteoarthritis
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Comparison aTSA vs rTSA

➢ J Shoulder Elbow Surg. 2015 Feb ➢ Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. Kiet TK, Feeley BT, Naimark M, Gajiu T, Hall SL, Chung TT, Ma CB. ➢ 2 yr f/u - 53 RCA - rTSA; 47 OA - TSA ➢ Complications: 15% TSA; 13% rTSA ➢ Revisions: 11% TSA; 9 % rTSA

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Sports after Hemi vs. rTSA

➢ J Shoulder Elbow Surg. 2016 Jun ➢ Sports after shoulder arthroplasty: a comparative analysis

  • f hemiarthroplasty and reverse total shoulder
  • replacement. Liu JN, Garcia GH, Mahony G, Wu HH,

Dines DM, Warren RF, Gulotta LV ➢102 rTSA - 71 Hemi; 1 yr; questionnaire ➢RTSports - 85.9% r TSA; 66.7% Hemi ➢Complaints - 29% rTSA; 63% Hemi

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Reverse under 65

➢ J Shoulder Elbow Surg. 2016 Aug ➢ Primary reverse shoulder arthroplasty in patients aged 65 years or younger. Samuelsen BT, Wagner ER, Houdek MT, Elhassan BT, Sánchez-Sotelo J, Cofield R, Sperling JW. ➢51 RC Arthropathy; 15 Severe OA ➢ 99% 2yr and 91% 5yr survival ➢No difference in complications ➢18% Notching; 3% Instability; No loosening

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rTSA Activity Level

➢ J Shoulder Elbow Surg. 2016; ➢ Younger patients report similar activity levels to older patients after rTSA. Walters JD, Barkoh K, Smith RA, Azar FM, Throckmorton, TW. ➢ 17 patients- 58 y/o; 29 patients - 75 y/o questionnaire ➢ 47% vs. 44% maintained high demand activities ➢ Concern about activity level with rTSA may be unwarranted ➢ Patients self-regulate activity

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Ø42/95 Original 5 yr Patients Ø91% Survivorship Ø2 revisions Ø1 Periprosthetic Fx Ø1 Dislocation ØNo Diminishment in ASES, ASES pain, SST

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My Results rTSA results > = aTSA results

➢Faster Recovery ➢Equal Activity level: Golf, Tennis, Swimming ➢Almost No Radiographic or Clinical Failures at 8 years ➢More revisions of aTSA than rTSA patients over same time period

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Radiographic Results

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Rehabilitation

My Philosophy

  • Place emphasis on patient’s role in recovery
  • Make it their responsibility - it’s their shoulder
  • Patient specific:

– Independent – Self Motivated – Physically able

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Rehabilitation

My Mantra

  • Home Therapy

5 x 5 Protocol Less than 5 minutes - 5 times a day

X

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Home Rehabilitation

  • Simple Exercises that patients can follow

– Safe – Effective – Reproducible – Using home equipment

  • < 5 minutes per session - 5 times a day
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Post Operative Treatment
 Third Month

  • Continue Shoulder Range-Of-Motion (TID)

– Table / Chair Slides (Warm Up) – Continue Bowing exercises

  • Introduce Wall Slides
  • Theraband Exercises

– Scapular Rows – Active Deltoid Strengthening (3 Heads)

  • Cryotherapy after rehab
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Return to Standard Physical Therapy

  • Failure to improve on their own

– Own admission – F/U Physical exam – especially stiffness

  • Desire to optimize result

– TSA – Rotator Cuff Repair – Return to sports (golf – tennis) Some people just love their therapist!

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6 Months Postop

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Shoulder Arthroplasty

➢Reverse shoulder arthroplasty, if done well, can give equal or better results compared with anatomic arthroplasty ➢Home Based Physical Therapy works best for most patients ➢Allow to return to All activities as tolerated!

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Thank You