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- 2. History • 1st performed in1893 • Charles Neer was the pioneer of modern shoulder replacement • In early 1950s hemiarthroplasty for complex shoulder fractures • In 1974 designed glenoid component to make 1st total shoulder replacement • In early 1990s Paul Grammont introduced reverse total shoulder arthroplasty
- 3. Shoulder complex Glenohumeral joint Anatomyand Biomechanics
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- 9. CLINICAL PRESENTATION Globalpain about shoulder with difficulty performing overhead activities and, often, activities of daily living. On P/E- diminished active and passive range of motion and may be diagnosed with adhesive capsulitis previously Palpable crepitus often elicited with passive internal and external rotation
- 10. RADIOGRAPHIC EVALUATION Standard radiographsinclude AP views with a 40-degree posterior oblique view in neutral position and internal and external rotation and an axillary lateral view.
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- 14. Objectives • Aims ofshoulder replacement are- 1. Abolish pain arising from a pathological glenohumeral joint and/or the rotator cuff 2. Restore a functional range of motion 3. Ensure that the above mentioned objectives last the lifetime of the patient
- 16. Hemiarthroplasty Indications (Matsen etal) Rough humeral joint surface with intact glenoid arc Insufficient bone to support a glenoid component Fixed upward displacement of humeral head relative to glenoid H/o remote joint infection heavy demands would be placed on the joint Contraindications Recent sepsis Neuropathic joint Paralytic disorder of the joint Deficiencies in shoulder cuff and deltoid muscle function Lack of patient cooperation.
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- 18. Total Shoulder Arthroplasty Indication: Endstage glenohumeral joint degeneration with an intact rotator cuff including osteoarthritis, rheumatoid arthritis, osteonecrosis, posttraumatic arthritis, and capsulorrhaphy arthropathy) Contraindication: Active or recent infection Irreparable rotator cuff tears. Paralysis with complete loss of function of the deltoid. Debilitating medical status and uncorrectable glenohumeral instability.
- 19. Reverse shoulder arthroplasty Indications 1.Cuff-tear arthropathy 2. Massive rotator cuff tear with pseudoparalysis 3. Severe inflammatory arthritis with a massive cuff tear 4. Failed shoulder arthroplasty 5. Absence of tuberosities (failed hemiarthroplasty for fracture/nonunion) 6. Absence of cuff (failed hemiarthroplasty for cuff-tear arthropathy) 7. Instability 8. Proximal humeral fracture 9. Proximal humeral nonunion 10. Reimplantation for deep periprosthetic infection 11. Reconstruction after tumor removal
- 20. • Contraindications Lossor inactivity of the deltoid Excessive glenoid bone loss
- 21. Complications of arthroplasty Glenoid loosening Glenohumeral instability Rotator cuff tear Periprosthetic fracture Infection Dissociation of modular prostheses Deltoid weakness or dysfunction Scapular notching Acromial and scapular spine fractures Loosening or dissociation of the humeral component Nerve injury
- 22. Rehabilitation Protocol AfterShoulder Arthroplasty POD1 to 6 weeks—Active assisted/Passive range of mottion only ■ Forward elevation—in the plane of the scapula as tolerated, up to 90 degrees ■ Internal rotation, with upper arm at side, to chest ■ External rotation, with upper arm at side, 0-20 degrees ■ Pendulum exercises five times per day ■ Active assisted→Active range of motion for elbow, wrist, and hand 6-12 weeks—continue Active assisted/Passive range of motion ■ Forward elevation to full ■ External rotation to 30 degrees
- 23. ■ Wand andoverhead pulley ■ Isometric strengthening for flexion, extension, external rotation, and abduction in neutral position only At 12 weeks—start Active range of motion/dynamic strengthening ■ Continue Active range of motion, stretches, and TheraBand strengthening ■ Progress strengthening ■ Progress to home program
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