Ashley Webb. initially designed and used in Europe in the late 1980s by Grammont only received FDA...
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Transcript of Ashley Webb. initially designed and used in Europe in the late 1980s by Grammont only received FDA...
REVERSE TOTAL SHOULDER
Ashley Webb
HISTORY
initially designed and used in Europe in the late 1980s by Grammont
only received FDA approval for use in the United States in March of 2004.
REASONS FOR SURGERY
Rotator Cuff is insufficient and damaged beyond repair
Failed total shoulder replacement
Deltoid muscle becomes the main movement component of the shoulder complex
CONTRAINDICATIONS FOR SURGERY
Structural or neurogenic lesion of the deltoid
Advanced glenoid destruction
Younger then 65 years old
THE SURGERY
The prosthesis works by:“Medializing the center of rotation of the
glenohumeral joint and distializing the insertion of the deltoid muscle, thereby increasing the lever arm”
OUTCOMES
Good outcomes
WNL for age in all planes of motionEXCEPT for Internal Rotation- with an average gain only at L5
REHAB PROTOCOLS
Deltoid repair takes 3-4 weeks to heal
High risk of shoulder dislocation
Avoid any extension past neutral especially combined with internal rotation
Sling worn for first 4-6 weeks
1-3 weeks: PROM flexion to 90, ER to 20-30
3-6 weeks: PROM flexion to 120, ER as tolerated, gentle isometrics
6-12 weeks: continue progressing PROM start Internal Rotation no greater then 50,
pt. can start using arm for ADL’s
9-12 weeks: AROM flexion in supine with weights (1-3 lbs.)
12-16 weeks: gentle resisted flexion in
standing, no sudden lifting or pushing
Discharge to a HEP when patient is able to perform 80-120 of flexion and 30 of ER
COMPLICATIONS
Glenosphere disengagement 24.4% of rTSA
Radiographic follow-up at 3 and 6 months Revisions in younger patients, if
asymptomatic no revision for older patients
REFERENCES
Abrahamsen, C. Rehabilitation Protocol After Reverse Total Shoulder Guery, et.al. 2007 Reverse Total Shoulder Arthroplasty: Survivorship
Analysis of Eighty Replacements Followed for Five to Ten Years. Oper Orthop Traumatol.17(1):1-24.
Guery, Favard, Sirveaux, Oudet, Mole, Walch. 2006 Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am. 88(8):1742-7.
Middernaught, De Wilde, Mole, Favard, Debeer. 2008. Glenosphere disengagement. The Association of Bone and Joint Surgeons. 466: 892-897.
Nicholson, G. 2006. Current concepts in reverse shoulder replacement. Current Opinion in Orthopedics. 17(4):306-309.
Replacement.Reverse Total Shoulder Arthroplasty Protocol Copyright © 2007 The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services. All rights reserved.
Walter W, Keyl W. 2005 Reverse total shoulder arthroplasty for the treatment of defect arthropathy. Oper Orthop Traumatol.17(1):1-24.