Total Shoulder Arthroplasty Flashcards
What two factors are important for a successful TSA?
1) Rotator cuff intact (isolated non-retracted tear of supraspinatus can proceed with TSA)
2) Appropriate glenoid bone stock and version
What are the outcomes of TSA?
1) pain relief most predictive benefit (more predictable than hemiarthroplasty)
2) reliable range of motion
3) good survival at 10 years (93%)
4) good longevity with cemented and press-fit humeral components
5) worse results for post-capsulorrhaphy arthropathy
What are contraindications to TSA?
1) insufficient glenoid bone stock
2) rotator cuff arthropathy
3) deltoid dysfunction
4) irreparable rotator cuff (hemiarthroplasty or reverse total shoulder are preferable); risk of loosening of the glenoid prosthesis is high (“rocking horse” phenomenon)
5) active infection
6) brachial plexus palsy
What are the solutions for gelnoid bone deficiency or retroverted gelnoid, during TSA?
1) Iliac crest bone autograft
2) Build up glenoid with allograft and eccentrically ream
What position should the humeral component be in a TSA, with relation to the greater tuberosity as well as version?
25-40° retroversion
Should be 5-8mm superior to GT
What is the limiting factor of TSA rehab?
Subscapularis repair; first 6 weeks only PROM or active assist ROM.
What is the MC cause of TSA failure?
Glenoid loosening; up to 30% of primaries for OA
Presence of radiographic lines do NOT correlate with symptoms; progression of radiographic lines DOES correlate with symptoms
What degree of glenoid retroversion cannot be corrected with eccentric anterior reaming during TSA?
> 15°
During the initial rehabilitation phase following total shoulder arthroplasty through a delto-pectoral approach, motion and strengthening are typically restricted because of which factor?
Protect the subscapularis repair
