Shoulder DJD in Athletic patient. What is Athletic? McCarty University of Colorado Fall Sports Medicine Symposium. Oct. 3, 2008
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1 Indications for Shoulder Arthroplasty in Athletic Patients Eric C. McCarty, M.D. Associate Professor, Dept. of Orthopaedics Chief, Sports Medicine and Shoulder Surgery Head Team Physician, University of Colorado Disclosure Disclosure Information The following relationships exist: Stryker, Smith Nephew - Institutional Support Biomet Sports Medicine - Consultant, Royalties Elesevier - Book Royalties DJO Royalties for Sling Shoulder DJD in Athletic patient What is Athletic? eric.mccarty@ucdenver.edu 1
2 Athletic Shoulder in the Rocky Mountains Athletic Shoulder in the South Athletic Young For Purposes of this Talk Age 60 or younger 2
3 What to do when all other treatments are unsuccessful? Prosthetic Options can be reliable way to decrease pain and to remain active Hemiarthroplasty/Humeral Head Resurfacing Total Shoulder Arthroplasty Indications in Athletic Patient Tried everything else Painful shoulder affecting athletic activity Decreased Range of Motion affecting activity Unable to adequately perform sports/activity Realistic expectations 3
4 Is this a controversial subject? Should athletic patients get shoulder replacement? TSA or Hemi? Loosening of the glenoid? Need for revision? Can they resume their sport? Why is this topic controversial? Multiple studies: TSA demonstrates improved predictability and quality of results compared with HHR CAVEAT: Glenoid loosening is still a problem! Hemiarthroplasty alone will work well in most patients Glenoid Loosening eric.mccarty@ucdenver.edu 4
5 Glenoid Loosening: Case Example Courtesy: Armand Hatzidakis, MD Retrieved Glenoid Component Decision Making Factors Age Activity Level Expectations Morphology/quality of the native glenoid 5
6 Focal Lesions Anatomic metal prosthesis Hemi Cap (Arthrosurface) Focal Lesions 29 yo Boxer Failed biologic procedures Focal Lesions 6
7 Focal Resurfacing Implants Have appeal due to limited size Easy to perform However, results not always satisfactory Conversion to full resurfacing sometimes necessary due to edge contact at periphery of implant Lack of studies in literature Humeral Head Replacement Resurfacing or Hemiarthroplasty stemless Humeral Head Replacement (HHR) Why HHR? Simple and fast Can work very well in many patients No polyethylene issues No activity restrictions Why not? Pain relief and functional results slightly inferior than TSA Inferior results in patients with eccentric glenoid posterior wear Postoperative glenoid erosion 7
8 Posteriorly Worn Glenoid with Posterior Subluxation: Poor Result with HHR Alone HHR Alone Best results in unworn or concentrically worn eburnated glenoids Humeral Head Resurfacing 8
9 Humeral Head Resurfacing oproposed advantages: Maintain bone stock Simple fast No Poly ethylene issues Minimal Activity restrictions JBJS 2011 Good results in 36 patients under age 50 (mean age 42.3 yrs) 3 year f/u Decrease in VAS pain from 7.5 to 1.3 at 36 months f/u Hemiarthroplasty Proposed advantages: Simple fast No Poly ethylene issues Minimal Activity restrictions Able to gain better visualization of glenoid then in resurfacing, thus can debride better and possibly try to ream the glenoid eric.mccarty@ucdenver.edu 9
10 JSES 2011 JSES 2011 Hemi-arthroplasty with concentric glenoid reaming Improvement in 56/65 patients age 55 or younger Simple Shoulder Test improved from 4.1 to 9.5 at 43 months Nine patients required revision surgery (including TSA, Reverse, repeat reaming) Total Shoulder Arthroplasty (TSA) Why TSA Best pain relief and ROM Best results over time AS A GROUP Why not? Technically more difficult Glenoid cement, polyethylene wear and loosening? Activity restrictions in younger patients eric.mccarty@ucdenver.edu 10
11 JBJS 2000 Prospective randomized study HHR VS TSA in concentric glenoids 47 patients, mean age 65 3/24 [12.5%] of HHR patients required revision within 48 months Posteriorly Worn Glenoid with Posterior Subluxation: Poor Result with HHR Alone JBJS (Br) 2008 Prospective study with mean age 55 years F/u of 7 years Sig. improvement in constant-murley score 24.1 to 64.5 No patients with implant loosening JSES 2011 Retrospective study with patients age 55 years or younger 46 TSA, 20 Hemiarthroplasties Implant survival at 10 years 92% TSA 72% Hemi- Patients with TSA had less pain, greater motion, higher satisfaction eric.mccarty@ucdenver.edu 11
12 Does Shoulder Arthroplasty work in the Athlete? 75 patients (86 shoulders) Avg. f/u 3.7 years (2 9.4 yrs.) Mean age at f/u 65.5 years (24 88) AJSM,2008 Results Return to Sports after Replacement Fishing Swimming Downhill Skiing Cross-Country Skiing Golf Tennis Squash/Racquetball 92% 86% 81% 78% 77% 75% 75% 12
13 Results Return to Sports after Replacement Rowing/Kayak/Canoe 60% Weight-Lifting Bowling 43% 40% Softball 20% Results Return to Sports Avg. time to partial return to sports: 3.6 months Avg. time to full return to sports: 5.8 months Conclusions of Sports after shoulder replacement Patients are able to successfully return to sports activities following shoulder arthroplasty A high return rate (> 75%) is seen in sports such as Swimming, Golf and Tennis A lower return rate (< 50%) is evident in sports such as weight lifting, bowling and softball Overall, patients undergoing shoulder arthroplasty returned with improved performance and increased frequency in sports participation in a timely manner eric.mccarty@ucdenver.edu 13
14 59 patients (61 shoulders) Avg. f/u 5.1 years ( yrs.) Avg age at surgery 48.9 years (25-55) AJSM,2017 Results Return to Sports after TSA in age 55 years and younger fitness sports (97.2%) golf (93.3%) singles tennis (87.5%) swimming (77.7%) basketball (75.0%) flag football(66.7%) Results Return to Sports after TSA in age 55 years and younger 82.4% returned to a similar or higher level of sports 90.3% returned to high-demand sports 83.8% returned to high upper extremity sports. eric.mccarty@ucdenver.edu 14
15 TSA is an option for sports! Summary Anatomic TSA Best chance (by a small amount) for short and long term pain relief with restoration of function. Patient with TSA must understand the brake pad analogy, and have reasonable expectations and goals Loosening is a potentially significant issue for active patients Summary Anatomic Humeral Head Replacement Intact glenoid cartilage or Eburnated concentric glenoid or Glenoid able to be reamed to neutral with normal stability and laxity eric.mccarty@ucdenver.edu 15
16 Keys to success Key to the success of arthroplasty in those that desire to return to more demanding sports is restoring soft tissue tension. Specifically, a complete 360 degree subscapularis release is needed to increase excursion and restore external rotation Keys to success This release will allow the humeral head to return to the center of the glenoid and permit the normal obligate translation that occurs with rotational motion. This helps to restore the normal forces across the glenohumeral joint and leads to decreased pain, improved strength and function. Keys to success Early Rehab to gain/maintain motion Protect Subscapularis eric.mccarty@ucdenver.edu 16
17 Shoulder Arthroplasty in the Active Patient Shoulder Arthroplasty in the the Athletic Patient Have informed discussion on options TSA might be better option in long run depending on age and activity Shoulder Arthroplasty in the Active Patient Shoulder Arthroplasty in the the Athletic Patient Information for patients considering Resurfacing/Hemi-Arthroplasty Potential for increased level of activity compared to TSA Potential for better longetivity without glenoid debris/loosening Slightly higher risk of unacceptable pain relief and decreased ROM compared to TSA and potential for early revision to TSA Need concentric Glenoid Shoulder Arthroplasty in the Active Patient Shoulder Arthroplasty in the the Athletic Patient My preference is Humeral head replacement with stemless or short stem in the young patient that is active in sports as long as there is a concentric glenoid Can resume almost all sports eric.mccarty@ucdenver.edu 17
18 THANK YOU 18
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Body Planes. (A) Transverse Superior Inferior (B) Sagittal Medial Lateral (C) Coronal Anterior Posterior Extremity Proximal Distal
Body Planes (A) Transverse Superior Inferior (B) Sagittal Medial Lateral (C) Coronal Anterior Posterior Extremity Proximal Distal C B A Range of Motion Flexion Extension ADDUCTION ABDUCTION Range of Motion
what you is back within LOVE arm s reach find out why the exactech shoulder may be right for you
TOTAL shoulder REPLACEMENT what you is back within LOVE arm s reach find out why the exactech shoulder may be right for you how does your shoulder work? The shoulder is the most mobile joint in the body.
A science-based protocol for the conservative and postoperative treatment of SLAP LESIONS & BICEPS PATHOLOGY
A science-based protocol for the conservative and postoperative treatment of SLAP LESIONS & BICEPS PATHOLOGY Prof dr Ann Cools, PT, PhD Dept Rehab. Sciences & Physiotherapy Ghent University, Belgium From
Challenges of Shoulder Arthroplasty
Challenges, Complications and Value Jonathan Levy, MD Shoulder & Elbow Surgeon Chief, Orthopaedic Surgery Holy Cross Hospital Medical Director, Holy Cross Orthopaedic Research Institute Director, ASES
DISCLOSURE FNFX ORIF OR ARTHROPLASTY? 11/21/2016 FEMORAL NECK FRACTURES: ORIF OR ARTHROPLASTY? ROYALTIES DEPUY, BIOMET
FEMORAL NECK FRACTURES: ORIF OR ARTHROPLASTY? GEORGE HAIDUKEWYCH, MD ORLANDO, FLORIDA DISCLOSURE ROYALTIES DEPUY, BIOMET CONSULTING DEPUY, SYNTHES, BIOMET, RESPONSIVE ORTHOPEDICS STOCK OWNERSHIP ORTHOPEDIATRICS
Christopher A Brown, MD Sports Medicine Orthopedist. Duke Orthopedic Residency Sports Medicine Fellowship Stanford
Christopher A Brown, MD Sports Medicine Orthopedist Duke Orthopedic Residency Sports Medicine Fellowship Stanford Office Geneva Newark Opening Canandaigua and Penfield Topics Of Discussion Shoulder dislocation
Disclosures. 55 year old Male 2/23/2018. Recurrent Hallux Rigidus: Options Other than Arthrodesis
Recurrent Hallux Rigidus: Options Other than Arthrodesis Gregory C Berlet, MD FRCS(C), FAOA Orthopedic Foot and Ankle Columbus, Ohio Columbus, Ohio orthofootankle.com Disclosures Consultant/Speaker Bureau/Royalties/
Progression to the next phase based on clinical criteria and time frames as appropriate
Indications Reverse total shoulder replacement is indicated for use in grossly rotator cuff deficient joints with severe arthropathy, or for use when a previous joint replacement has failed with a grossly
Integra. Titan Modular Shoulder System, 2.5
Titan Modular Shoulder System, 2.5 Limit uncertainty with a shoulder implant system that redefines modularity, addresses multiple indications, and allows for reproducible results. Titan Modular Shoulder
Revision of the humeral component for aseptic loosening in arthroplasty of the shoulder
Revision of the humeral component for aseptic loosening in arthroplasty of the shoulder A. Cil, C. J. H. Veillette, J. Sanchez-Sotelo, J. W. Sperling, C. Schleck, R. H. Cofield From the Mayo Clinic, Rochester,