Shoulder Arthroplasty PDF

Shoulder arthroplasty By Adel Sallam, MD Lecturer of orthopedics, Tanta university, Egypt Clinical fellow at CTO, Torino University, Italy  Shoulder Hemiarthroplasty?? Total Shoulder arthroplasty?? Reversed Shoulder arthroplasty?  Shoulde...

Shoulder arthroplasty By Adel Sallam, MD Lecturer of orthopedics, Tanta university, Egypt Clinical fellow at CTO, Torino University, Italy  Shoulder Hemiarthroplasty?? Total Shoulder arthroplasty?? Reversed Shoulder arthroplasty?  Shoulder Hemiarthroplasty Reversed Shoulder arthroplasty Total Shoulder arthroplasty Hemi arthroplasty Total Shoulder Arthroplasty Indications : end stage arthritis Reverse total shoulder Approach Deltopectoral Complications : axillary nerve  Rehabilitation Passive or active-assisted motion only during early rehab limiting factor in early postoperative rehabilitation is risk of injury to the subscapularis tendon repair Progress to ER isometrics Limit passive external rotation risk of tear and pull-off of subscapularis tendon from anterior humerus tear leads to anterior shoulder instability (most common form of instability after TSA) treatment of subscapularis pull-off is early exploration and repair of tendon test for pull-off of subscapularis weak belly-press test inability to put hand in back pants pockets or tuck shirt behind the back avoid pushing out of chair during acute rehab IR eccentric and isometric Post-operative pain control Preoperative narcotic associated with increased post-operative narcotic use  Complications Glenoid loosening Glenoid arthrosis Vascular injury Humeral stem loosening - more common in RA and osteonecrosis - rule out infection Subscapularis repair failure Improper soft tissue balancing Iatrogenic rotator cuff injury/attritional rotator cuff tear Stiffness Infection instability  Neurologic injury axillary nerve is most commonly injured inferior border of subscapularis tendon can be used as a landmark to identify axillary nerve as it courses from anterior to posterior musculocutaneous nerve can be injured by retractor placement under conjoint tendon Periprosthetic fracture Thank You ?? [email protected] 0201008426084