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Shoulder Arthroplasty WIC - Dr. LS
Shoulder Arthroplasty WIC - Dr. LS
ARTHROPLASTY
Pembimbing :
dr. Rr. Indrayuni Lukitra W., Sp.KFR-K
References
Ellenbecker, TS., and Wilcox, RB., 2018. Rehabilitation Following Total Shoulder and Reverse Total
Shoulder Arthroplasty in Clinical Orthopaedic Rehabilitation : A Team Approach 4 th ed.
Philadelphia, PA : Elsevier
Lin et al . 2016. Shoulder Arthroplasty, from Indications to Complications: What the Radiologist
Needs to Know.. RadioGraphics 2016; 36:192–208 . RG • Volume 36 Number 1
Carpenter et al, 2016. Porous Metals And Alternate Bearing Surfaces In Shoulder Arthroplasty.
Curr Rev Musculoskelet Med (2016) 9:59–66 DOI 10.1007/s12178-016-9319-x
Werthel et al, 2017. Long-term Outcomes Of Cemented Versus Cementless Humeral Components
In Arthroplasty Of The Shoulder. Bone Joint J2017;99-B:666–73.
Indications for Shoulder
Arthroplasty
1) Osteoarthritis
2) Rheumatoid arthritis
3) Irreparable Rotator Cuff Tears and Rotator Cuff Arthropathy
4) Humeral Head Avascular necrosis
5) Post-traumatic arthritis
6) Severe proximal humeral fractures
Contraindications to
Shoulder Arthroplasty
1) Hemiarthroplasty :
where only part of the glenohumeral joint is replaced, typically the humeral head
Hemiarthroplasty
Reverse Total Shoulder
Arthroplasty
Total Shoulder
Arthroplasty
Hemiarthroplasty vs Total Shoulder
Arthroplasty
In the initial development of total shoulder arthroplasty (TSA), the humeral component
was usually fixed with cement. Cementless components were subsequently introduced.
The aim of this study was to compare the long-term outcome of cemented and
cementless humeral components in arthroplasty of the shoulder.
Conclusion : Both types of fixation give rates of long-term survival of > 90%.
Cemented components have better rates of survival without loosening but this should
be weighed against increased operating time and the risk of bony destruction of the
proximal humerus at the time of revision of a cemented humeral component.
Infection
Infection can occur in the setting of any type of shoulder arthroplasty but
is most commonly seen after reverse arthroplasty
Neurological Complications
Axillary nerve injury. Rare, higher risk during revision surgery. Usually a neuropraxia
Subscapularis Precautions
These active-assistive exercises can be performed with cane exercise and or table
walkouts.
The patient should also start scapular mobility in the sling including elevation and
depression and scapular retraction.
At 1 week, the patient may start submaximal isometric exercises into
flexion, extension, abduction, and external rotation.
Use of the upper body ergometer and overhead pulleys may be added as
patient tolerance allows
Fig. 2.23 Prone row with Fig. 2.24 Prone abduction with Fig. 2.25 Prone extension
focus on good middle focus on middle and lower with focus on middle and
trapezius recruitment trapezius lower trapezius
Fig. 2.26 Lawnmower starting position— Fig. 2.27 Lawn mower ending position—with
cue to pull up like starting a lawn scapula retraction
mower
Fig. 2.28 Side-lying external rotation Fig. 2.30 Supine shoulder flexion
Full passive and active range of motion with the restriction of 60° of exercise
rotation should be obtained.
Progressive resistive exercises and proprioceptive activities continue for the
rotator cuff and periscapular musculature with body blade exercises
progressing into higher angles of elevation.
Scapular control exercises in closed chain position should be initiated as well
As the patient shows improved strength and motor control, closed
chained activities can be moved into quadruped.
Weakness may still be present in the subscapularis if it was resected
during surgery, so attention should be paid to restore strength with
dynamic hug-type exercises
Exercises should also reflect more functional movement strength such
as diagonal patterns
Fig. 2.40 Patient can perform circles, serratus Fig. 2.42 Dynamic hug exercise—cue is
press/scapular retraction, to reach around like a hug
or rhythmic stabilization with therapist
Fig. 2.45 Bodyblade at 90° abduction Fig. 2.46 Bodyblade at 90° flexion
single hand single hand
Postoperative (Weeks 12+)
Focus at this point should be returning the patient to their individual goals,
recreational activity, and job duties if applicable.
Patient will most likely be on a home program by this point for gradual
return to full strength and regular daily activities.
Sport- or recreational activity-specific exercises should be part of the overall
program.
Weight-Bearing Upper Extremity
Kirsch and Namdari, 2020. Rehabilitation After Anatomic and Reverse Total Shoulder Arthroplasty :
A Critical Analysis Review. JBJS REVIEWS 2020;8(2):e0129 · http://dx.doi.org/10.2106/JBJS.RVW.19.00129
rTSA
The role of rTSA in the management of CTA is clinically sound as it alters
the mechanics of the shoulder to enhance deltoid function in the
absence of a competent RC.
Hence, the postoperative course for a patient following rTSA is different
from the rehabilitation following a traditional TSA.
The physical therapist, surgeon, and patient should work together
when establishing the postoperative rehabilitation plan focused on
joint protection, deltoid function, and the establishment of appropriate
functional and measurable goals.
Avoid Positions that Lead to Instability
Conclusions:
Both early (immediate physical therapy for passive and active ROM) and
delayed-ROM protocols (no ROM for 6 weeks) after RTSA demonstrated
significant, similar improvements in ROM and outcomes.
Hagen et al. 2019. A Randomized Single-blinded Trial Of Early Rehabilitation Versus Immobilization After
Reverse Total Shoulder Arthroplasty. J Shoulder Elbow Surg (2019) -, 1–9
THANK YOU
Humeral Components
CEMENTED PROX POROUS FULLY POROUS
COATED COATED
Less stress-shielding
More stress-shielding More stress-shielding
Easier to revise
Hard to revise Hard to revise