Wednesday, November 18, 2015

Cuff tear arthropathy treatment with a CTA prosthesis

At at time when may surgeons 'automatically' use a reverse total shoulder in the management of cuff tear arthropathy, we continue to consider the much more conservative and more robust CTA prosthesis in stable shoulders with active elevation above 90 degrees. Here's an example from yesterday's OR. 

The preoperative film shows 'femoralization' of the proximal humerus and 'acetabularization' of the coracoacromial arch and glenoid. The humeral head is riding superiorly in the glenoid.

The postoperative films show the impaction grafted CTA prosthesis in place with restoration of the normal glenohumeral relationships.

The patient achieved comfortable 150 degrees of assisted elevation the night of surgery.

The surgical technique and a video of the functional result possible with this approach is shown in this link.

Note that should this conservative, bone-conserving procedure fail (which is uncommon in our hands), conversion to a reverse total shoulder is straightforward.


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