1. Reverse Total Shoulder Arthroplasty for Repair of Failed Shoulder Hemiarthroplasty in a Young Patient: A Case Report Sam Vaid, Tyler Shultz, Craig Garrison, Lori Bolgla

3. RC Tears, RA, OA, Impingement, Fractures

4. Causes ↑ pain, ↓ ROM, ↓Strength, ↓ Function

6. Reverses normal anatomical design

7. Utilizes deltoid to compensate for deficient RC

8. Yields ↓ pain, ↑ ROM, ↑ Strength, ↑ Function

11. Traumatic dislocation at age 18

12. Multiple Stabilization procedures over 30 years

13. Received hemiarthroplasty at age of 49

16. ROM, Function, Pain

17. Active IR ↑ from Rt. Iliac crest to L1

18. Most apparent ↑ was in functional level

19. Initiated golf, tennis, fishing 4 months post

20. Full recovery without any limitations with these activities 8 months post

21. Radiographs taken 8 months post

22. Prosthesis secure & in place

25. Pt.’s Hx of traumatic shoulder injury

27. Conclusions HCP’s should consider rTSA in younger patients A standardized rehabilitation protocol should be developed to return patients to optimal function after surgery

28. Bottom Line “rTSA was effective at increasing ROM, strength, and functional activity in a highly active male who experienced failed hemiarthroplasty for traumatic RC arthropathy” The results suggest that rTSA may be a viable option for younger, highly active patients

29. Questions

30. References 1. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8(4):296-299. 2. Levy J, Virani N, Pupello D, Frankle M. Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. Journal of Bone and Joint Surgery. 2007;89(2):189. 3. Rittmeister M, Kerschbaumer F. Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions. J Shoulder Elbow Surg. 2001;10(1):17-22. 4. Middernacht B, De Wilde L, Molé D, Favard L, Debeer P. Glenosphere Disengagement: A potentially serious default in reverse shoulder surgery. Clinical Orthopaedics and Related Research. 2008;466(4):892-898. 5. Frankle M, Siegal S, Pupello D, et al. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87(8):1697-1705. 6. Guery J, Favard L, Sirveaux F, et al. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am. 2006;88(8):1742-1747. 7. Roberts C, Ekelund A, Renfree K, Liu P, Chew F. Radiologic assessment of reverse shoulder arthroplasty. RadioGraphics. 2007;27:223-235. 8. Drake GN, O'Connor DP, Edwards TB. Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease. ClinOrthopRelat Res. 2010. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20049573 [Accessed April 16, 2010]. 9. Wall B, Nové-Josserand L, O'Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89(7):1476-1485. 10. Wierks C, Skolasky R, Ji J, McFarland E. Reverse Total Shoulder Replacement: Intraoperative and Early Postoperative Complications. Clinical Orthopaedicsand Related Research®. 2009;467(1):225-234. 11. Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am. 2007;89(2):292-300. 12. Seebauer L, Walter W, Keyl W. Reverse total shoulder arthroplasty for the treatment of defect arthropathy. OperOrthopTraumatol. 2005;17(1):1-24. 13. Hatzidakis A, Norris T, Boileau P. Reverse Shoulder Arthroplasty Indications, Technique, and Results. Techniques in Shoulder & Elbow Surgery. 2005;6(3):135-149. 14. Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008. 15. Proaxis Therapy. Reverse Total Shoulder Arthroplasty Patient Flow Sheet. 2007. 16. Boudreau S, Boudreau E, Higgins L, Wilcox R. Rehabilitation following reverse total shoulder arthroplasty. Journal of Orthopaedic and Sports Physical Therapy. 2007;37(12):734-743. 17. Kontaxis A, Johnson GR. Adaptation of scapula lateral rotation after reverse anatomy shoulder replacement. Computer Methods in Biomechanics & Biomedical Engineering. 2008;11(1):73-80. 18. Walch G, Mottier F, Wall B, et al. Acromial insufficiency in reverse shoulder arthroplasties. Journal of Shoulder and Elbow Surgery. In Press, Corrected Proof. Available at: http://www.sciencedirect.com/science/article/B6WM1-4VPV8X4-1/2/881dff574c6de509102f666da98c6146 [Accessed March 14, 2009]. 19. Gutiérrez S, Greiwe RM, Frankle MA, Siegal S, Lee WE. Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder Elbow Surg. 2007;16(3 Suppl):S9-S12. 20. Bergmann J, de Leeuw M, Janssen T, Veeger D, Willems W. Contribution of the Reverse Endoprosthesis to Glenohumeral Kinematics. Clinical Orthopaedics and Related Research. 2008;466(3):594-598.