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.