Expanding Indications of Reverse Shoulder Arthroplasty Derek Cuff

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Expanding Indications of Reverse Shoulder Arthroplasty Derek Cuff, M. D. Suncoast Orthopaedic Surgery and

Expanding Indications of Reverse Shoulder Arthroplasty Derek Cuff, M. D. Suncoast Orthopaedic Surgery and Sports Medicine 5 th Annual Gulfcoast Rehab Conference

Disclosures • DJO Surgical – Consultant – Implant design

Disclosures • DJO Surgical – Consultant – Implant design

Expanding Use of RSA • Goals 1. Discuss mechanics of RSA 2. Discuss why

Expanding Use of RSA • Goals 1. Discuss mechanics of RSA 2. Discuss why its use is growing 3. Discuss how this affects PT/OT practice

Expanding Use of RSA

Expanding Use of RSA

Expanding Use of RSA • FDA approved for use in 2003 • Used since

Expanding Use of RSA • FDA approved for use in 2003 • Used since the early 1990’s in Europe • Initially approved for treatment of cuff tear arthropathy

Expanding Use of RSA

Expanding Use of RSA

Expanding Use of RSA

Expanding Use of RSA

Expanding Use of RSA • 2008 JBJS publication- Cuff et al. • 112 patients

Expanding Use of RSA • 2008 JBJS publication- Cuff et al. • 112 patients (114 shoulders) • 94% satisfaction rating • Dramatic improvements in ROM

Expanding Use of RSA • Cuff et al 2017 • Same cohort now with

Expanding Use of RSA • Cuff et al 2017 • Same cohort now with minimum 10 year f/u • 42 patients left, avg f/u 11 years • Maintained excellent outcomes • 91% survivorship for implant

Expanding Use of RSA • Good results = search for new indications • Severe

Expanding Use of RSA • Good results = search for new indications • Severe fractures in the elderly

Expanding Use of RSA

Expanding Use of RSA

Expanding Use of RSA • High failure rate of healing of tuberosities in elderly

Expanding Use of RSA • High failure rate of healing of tuberosities in elderly • 55 -60% success rate • Many patients do not regain overhead use

Expanding Use of RSA

Expanding Use of RSA

Expanding Use of RSA • JBJS 2013 Cuff et al. • 91% success rate

Expanding Use of RSA • JBJS 2013 Cuff et al. • 91% success rate RSA vs 61% of hemi • Avg. forward elevation 1400

Expanding Use of RSA • What we have learned: – Great implant for any

Expanding Use of RSA • What we have learned: – Great implant for any potential rotator cuff deficiency – Great for any instability issues – Rigid reliable fixation of implant even in bad bone or bone loss cases This has led to an explosion of indications and use

LAST 12 Months 12 different indications

LAST 12 Months 12 different indications

Expanding Use of RSA • What does this mean for therapist? • Going to

Expanding Use of RSA • What does this mean for therapist? • Going to see a lot more of these patients • Not a surgery just for shoulder specialists anymore • All surgeons go through a learn curve

Expanding Use of RSA • What am I seeing?

Expanding Use of RSA • What am I seeing?

Expanding Use of RSA • What to watch out for? – Understand the indication

Expanding Use of RSA • What to watch out for? – Understand the indication – Different diagnosis = different results/concerns – Fully understand the surgeons rehab protocol – Wide variation in how these are rehab

Expanding Use of RSA • Mistakes to avoid – Overaggressive PT – Dislocation IS

Expanding Use of RSA • Mistakes to avoid – Overaggressive PT – Dislocation IS a risk

Expanding Use of RSA • Acromial fractures • Now the most common complication after

Expanding Use of RSA • Acromial fractures • Now the most common complication after RSA • 3% incidence nationally • Typically occur 3 -4 months post op

Expanding Use of RSA • Acute pain posterior-lateral aspect of shoulder • Cant raise

Expanding Use of RSA • Acute pain posterior-lateral aspect of shoulder • Cant raise arm at all • Stop all PT/OT • Notify MD ASAP

Expanding Use of RSA

Expanding Use of RSA

Expanding Use of RSA • What causes these fx’s? ? • No one knows

Expanding Use of RSA • What causes these fx’s? ? • No one knows • Some have concerns about PT

Expanding Use of RSA • My PT protocol: – Weeks 0 -6 weeks immobilizer-

Expanding Use of RSA • My PT protocol: – Weeks 0 -6 weeks immobilizer- Pendulums only and elbow/wrist/hand ROM – Weeks 6 -8 passive ROM – Weeks 8 -10 passive and AA ROM – Weeks 10 -12 advancing AROM – Week 12 start light deltoid strengthening

Summary • Use of RSA has skyrocketed • Used to treat a myriad of

Summary • Use of RSA has skyrocketed • Used to treat a myriad of pathology • PT/OT going to be involved in post-op • Beware of pitfalls (instability and acromial fx)

Thank You

Thank You

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