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2009--Recovery Trends in TSA Patients


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A summary of the research I carried out at the Cleveland Clinic during my summer internship with Dr. William H. Seitz.

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2009--Recovery Trends in TSA Patients

  1. 1. Recovery Trends in Total Shoulder Arthroplasty Patients August 3rd, 2009 Colin P. Ryan William H. Seitz Jr, M.D
  2. 2. <ul><li>Total Shoulder Arthroplasty (TSA): </li></ul><ul><ul><li>Popularized in the 1970’s </li></ul></ul><ul><ul><li>Dr. Charles Neer—Mark I, II, III Prosthesis </li></ul></ul>About TSA Neer II *Modified Mark III Prosthesis still currently used
  3. 3. Background <ul><li>Few reports and studies have been able to convey the possible outcomes of undergoing surgery. </li></ul><ul><li>Previous studies indicate that significant improvements were seen in most patients with 2+ years of recovery following total shoulder arthroplasty (TSA). </li></ul>
  4. 4. Conservative Treatment Options <ul><li>Rest </li></ul><ul><li>Ice/Heat/Compression therapy </li></ul><ul><li>Anti-inflammatory medications </li></ul><ul><li>Corticosteroid treatment (final option) </li></ul>
  5. 5. Indications for Total Shoulder Arthroplasty <ul><li>End-stage osteoarthritis </li></ul><ul><ul><li>Following failure of conservative treatment </li></ul></ul><ul><li>Rheumatoid arthritis </li></ul><ul><li>Traumatic shoulder injury </li></ul><ul><li>Chronic/recurrent dislocation </li></ul><ul><li>Chronic massive/full thickness rotator cuff tear </li></ul><ul><li>Tumor </li></ul>
  6. 6. VS. Normal Shoulder Anatomy Arthritic Shoulder Joint
  7. 7. <ul><li>Total Shoulder Prosthesis </li></ul><ul><li>This is an ideal implantation of a total shoulder prosthesis with a humeral head that closely mimics normal shoulder anatomy. </li></ul>
  8. 8. Cup Shoulder Prosthesis <ul><li>Replaces the surface of the humeral head. </li></ul><ul><li>Used in rheumatoid arthritis patients </li></ul><ul><li>Improvement in motion, function, and pain relief </li></ul>
  9. 9. <ul><li>Reverses the normal anatomy </li></ul><ul><li>Used for irreparable rotator cuff disorders / revision procedures. </li></ul><ul><li>Deltoid is used to raise and lower the arm. </li></ul>Reverse Total Shoulder Prosthesis
  10. 10. How does TSA impact patients’ lives? <ul><li>Proven efficacy of TSA </li></ul><ul><ul><li>Multitude of studies present benefits of TSA in statistical format </li></ul></ul><ul><ul><li>Few convey possible outcomes to patients </li></ul></ul><ul><li>What will be affected by having this operation? </li></ul><ul><li>Will my shoulder be like normal? </li></ul>
  11. 11. Benefits of Survey Completion for Patients <ul><li>1 st Goal : Provide prospective patients with meaningful information concerning TSA </li></ul><ul><ul><li>How will surgery affect activities of daily living (i.e. bathing, sleeping, driving, dressing, etc.). </li></ul></ul><ul><li>2 nd Goal : Determine if recovery trends exist </li></ul><ul><li>3 rd Goal : Determine which diagnostic group benefits most from TSA and, if existent, which has the most normal recovery trend </li></ul><ul><ul><li>Osteoarthritis, Rheumatoid Arthritis (RA), Cuff Tear Arthropathy (CTA) </li></ul></ul>
  12. 12. Methodology <ul><li>TSA patients were contacted via phone or during routine office visits. </li></ul><ul><ul><li>Questionnaire study </li></ul></ul><ul><ul><li>Asked to compare postoperative status to preoperative status </li></ul></ul><ul><li>Impact on ADLs (Activities of Daily Living) </li></ul><ul><li>Benefited and satisfied </li></ul><ul><li>Procedure again? </li></ul><ul><li>Patients’ responses added to a previously developed database. </li></ul>
  13. 14. Average ADL Results for all TSA Patients
  14. 15. Trendline of the Average ADLs of all TSA Patients Postoperatively
  15. 18. “ Are you satisfied with the function of your new shoulder?”
  16. 19. “ Have you benefited from your shoulder replacement?”
  17. 20. “ Would you repeat this procedure, based on your results?”
  18. 21. Discussion <ul><li>All ADLs were positive </li></ul><ul><ul><li>Some ADLs more positive than others </li></ul></ul><ul><ul><li>Bathing, eating, sleeping, driving, dressing, and household chores </li></ul></ul><ul><ul><li>Patients able to live independently </li></ul></ul>
  19. 22. Recommendations <ul><li>Therapy before and after surgery </li></ul><ul><ul><li>Paramount to allow achievable ROM, prevent shoulder stiffness, weakness </li></ul></ul><ul><li>Two full years for total recovery to occur </li></ul><ul><li>Early mobilization = better range of motion, prevents shoulder stiffness / weakness. </li></ul><ul><li>End-stage CTA patients need to be informed of RTSA’s limited efficacy. </li></ul><ul><li>“ Limited goals” </li></ul>
  20. 23. Acknowledgments <ul><li>Mrs. Rosalind Strickland </li></ul><ul><li>Ms. Nedra Starling </li></ul><ul><li>Mrs. Mary Intorcio </li></ul><ul><li>Mr. Jayson D. Zadzilka, M.S </li></ul><ul><li>Special Thanks to William H. Seitz Jr, M.D. for his support and guidance throughout this project. </li></ul><ul><li>Cleveland Orthopaedic and Spine Hospital Staff. </li></ul>
  21. 24. <ul><li>  </li></ul><ul><li>Bryant, D., Litchfield, R., Sandou, M., Gartson, G. M., Guyatt, G., & Kirkley, A. (2005). A Comparison of Pain, Strength, Range of Motion and Functional Outcomes after Hemiarthroplasty and Total Shoulder Arthroplasty in Patients with Osteoarthritis of the Shoulder. The Journal of Bone and Joint Surgery , 87 , 1947-56. </li></ul><ul><li>Gordiev K and Seitz WH Jr.: Avoiding and Managing the Unstable Shoulder Arthroplasty, Semin Arthro 15:12 225-27, 2004. </li></ul><ul><li>Jonsson, E., Egund, N., Kelly, I., Ryaholm, U., & Lidgren, L. (1986). Cup Arthroplasty of Rheumatoid Shoulder. Acta Orthop (57), 542-46. </li></ul><ul><li>Lo, I. K., Litchfield, R. B., Griffin, S., Faber, K., Paterson, S., & Kirkley, A. (2005). Quality-of-Life Outcome Following Hemiarthroplasty or Total Shoulder Arthroplasty in Patients with Osteoarthritis. The Journal of Bone and Joint , 87 , 2178-85. </li></ul><ul><li>Orfaly, Robert M., Rockwood, Charles, Esenyel, Cem Zeki, and Wirth, Michael A. (2003). &quot;A Functional Outcome Study of Shoulder Arthroplasty for Osteoarthritis with an Intact Rotator Cuff.&quot; The Journal of Shoulder and Elbow Surgery. 12 , 215-21. </li></ul><ul><li>R. Z. Tashjian, R.F. Henn, L. Kang, and A. Green. (2004). “The Effect of Comorbidity on Self-Assessed Function in Patients with a Chronic Rotator Cuff Tear.” The Journal of Bone and Joint Surgery . 86 , 355-62. </li></ul><ul><li>Seitz WH Jr.: Cup Arthroplasty for Shoulder Resurfacing: Technical Tips and “Pearls,” Semin Arthro 18(1):33-41, March 2007. </li></ul><ul><li>Seitz WH Jr.: Surface Replacement: A Head is all that’s Required- in the Affirmative, Semin Arthro , 15:12-18, 2004. </li></ul><ul><li>Seitz WH Jr.: Managing Contractures in Total Shoulder Arthroplasty: “Sore, stiff, and stuck.” Seminars in Arthroplasty 14:1- 9, 2003. </li></ul><ul><li>Seitz WH Jr.: The Delta Experience…“does it fly”? Semin Arthro , 16:268-73, 2005 </li></ul><ul><li>Sperling JW, Cofield RH, Rowland CM. (1998) “Neer Hemiarthroplasty and Neer in Total Shoulder Arthroplasty in Patients Fifty Years Old or Less. Long Term Results.” The Journal of Bone and Joint Surgery . 80 , 464-73. </li></ul>References