Saturday, November 30, 2013

Cuff tear arthropathy arthroplasty

A discussion of the management of the rotator cuff deficient shoulder is provided in this link.

1. Description - a surgical procedure for the combined problems of glenohumeral arthritis and rotator cuff deficiency in which the humeral articular surface is replaced into the socket consisting of the upper glenoid and the coracoacromial arch. A special prosthesis is used for this surgery that articulates with the undersurface of the arch.

2. Indications - shoulders with the diagnosis of rotator cuff tear arthropathy in the absence of pseudo paralysis and in the absence of anterosuperior escape. Specifically, we require an intact coracoacromial arch and active flexion of the arm greater than 90 degrees. This procedure is a good alternative to a reverse total shoulder in individuals who wish to remain physically active and in individuals prone to falling.

A discussion of the CTA prosthesis is provided in this link.

3. Technique - the technique for the CTA arthroplasty is very similar to that of the hemiarthroplasty. The important difference is that we preserve not only the coracoacromial arch and acromion, but also the upper aspect of the clavipectoral fascia as it inserts into the coracoacromial ligament (we call this the CA+). It is important to match the diameter of curvature of the native humeral head in that the glenoid anatomy is not altered. It is also important to effect a secure repair of he subscapularis. and to protect it during recovery.

Antibiotics after joint replacement

4. Rehabilitation - The most important aspect of the post operative rehab program is preventing stiffness - using the exercises shown here. Of particular concern is the subscapularis.

Once the range of motion is well established and after 6 weeks, we usually start early strengthening and the traction three.

5. Results - The functional result of the CTA arthroplasty can be excellent if the pathology and the patient are appropriate and if the procedure is well done.

6. Complications - the possible risks of CTA hemiarthroplasty include stiffness, pain, infection, fracture, socket wear and instability.

**To see more of the Shoulder Arthritis Book, click here.**