Reverse total shoulder arthroplasty in wheelchair-dependent patients
Section snippets
Materials and methods
A retrospective study was performed of clinical data obtained in a prospective manner from all patients who consented to the University of Florida Shoulder Arthroplasty Database. All surgeries were done at a tertiary referral center (University of Florida). All but one of these procedures was completed by the senior surgeon (T.W.W.). The inclusion criteria were patients aged 18 years or older who relied on a wheelchair as their primary means of ambulation and who underwent RTSA between January
Results
Review of the database identified 19 shoulders represented by 16 patients as potentially eligible for inclusion based on the criteria of our Institutional Review Board. An initial review of these 19 shoulders revealed that the implants failed in 3 patients shortly after surgery for a failure rate of 15.8% of eligible cases performed (Table I). One failure occurred when a patient with severe Parkinson disease fell 6 weeks postoperatively and dislodged the baseplate. Two other failures, both
Discussion
The literature is sparse concerning discussion of surgical treatment of shoulder pathology in patients with LEI, especially those who are wheelchair-dependent. Possible reasons for this may be the relative rarity of these patients combined with surgeon concerns of excessive postoperative forces, difficulty adhering to restrictions, and potential early failure. Four studies examining shoulder surgery in patients with paraplegic LEI were identified. Two of these articles, those by Hattrup et al9
Conclusion
RTSA is a viable option for wheelchair-dependent patients with symptomatic shoulder arthritis or cuff failure. These patients must be willing to fully cooperate with the postoperative therapy protocol, including no weight-bearing transfers with the operative arm for a minimum of 12 weeks. To be compliant with this plan, most patients will require 6 to 12 weeks in a rehabilitation facility. In addition, a successful RTSA has the ability to restore independent transfer and reach without pain, but
Disclaimer
Thomas W. Wright and Kevin W. Farmer receive royalties from Exactech Inc. The University of Florida receives research support from Exactech Inc. The other authors, their immediate families, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
Acknowledgements
The authors thank Aimee M. Struk, MEd, MBA, ATC, LAT, their research assistant and a certified athletic trainer, for contributing substantially in identifying prospective subjects, compiling data, and ensuring timely incorporation of new clinical data. The authors thank Sonya T. Brisbane, MPH, for facilitating patient enrollment and coordinating Institutional Review Board approval and compliance.
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2022, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :In the case of glenohumeral OA or rotator cuff tear arthropathy, the indication for shoulder replacement is controversial, with reluctance being due to the large stresses applied to the implants. Despite the high prevalence of such lesions in weightbearing shoulders, few studies have reported the outcomes of joint replacement; those that did had a low sample size [13–16]. The primary aim of our study was to show that arthroplasty on a weightbearing shoulder would lead to less pain, with positive impact on the patient's locomotion and autonomy, with no increase in the complication rate.
The University of Florida Gainesville Health Science Center Institutional Review Board approved this study (IRB#: IRB201300308).