Total Shoulder Arthroplasty Flashcards

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1
Q

What two factors are important for a successful TSA?

A

1) Rotator cuff intact (isolated non-retracted tear of supraspinatus can proceed with TSA)
2) Appropriate glenoid bone stock and version

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2
Q

What are the outcomes of TSA?

A

1) pain relief most predictive benefit (more predictable than hemiarthroplasty)
2) reliable range of motion
3) good survival at 10 years (93%)
4) good longevity with cemented and press-fit humeral components
5) worse results for post-capsulorrhaphy arthropathy

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3
Q

What are contraindications to TSA?

A

1) insufficient glenoid bone stock
2) rotator cuff arthropathy
3) deltoid dysfunction
4) irreparable rotator cuff (hemiarthroplasty or reverse total shoulder are preferable); risk of loosening of the glenoid prosthesis is high (“rocking horse” phenomenon)
5) active infection
6) brachial plexus palsy

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4
Q

What are the solutions for gelnoid bone deficiency or retroverted gelnoid, during TSA?

A

1) Iliac crest bone autograft

2) Build up glenoid with allograft and eccentrically ream

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5
Q

What position should the humeral component be in a TSA, with relation to the greater tuberosity as well as version?

A

25-40° retroversion

Should be 5-8mm superior to GT

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6
Q

What is the limiting factor of TSA rehab?

A

Subscapularis repair; first 6 weeks only PROM or active assist ROM.

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7
Q

What is the MC cause of TSA failure?

A

Glenoid loosening; up to 30% of primaries for OA
Presence of radiographic lines do NOT correlate with symptoms; progression of radiographic lines DOES correlate with symptoms

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8
Q

What degree of glenoid retroversion cannot be corrected with eccentric anterior reaming during TSA?

A

> 15°

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9
Q

During the initial rehabilitation phase following total shoulder arthroplasty through a delto-pectoral approach, motion and strengthening are typically restricted because of which factor?

A

Protect the subscapularis repair

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