Total Shoulder Design Innovations Advance Outcomes

[mtomaino]

Total Shoulder Replacement has come a long way since it was originally introduced. For years the humeral replacement imitated the femoral component of a total hip, and similar to early designs for that joint--one size fit all. There was no such thing as "modularity", thus patients with different anatomy received the same implant. Dial forward to 2010 and innovations in total shoulder designs have addressed variations in anatomy. When it comes to the shoulder, this means size of head and glenoid, neck inclination, version and offset. Indeed, though intuitive, functional outcomes do improve when the "replacement" replicates the patient's "pre-arthritis" anatomy.

The newest designs have shortened the stems--reflecting our understanding that fixation is mostly metaphyseal-not from the stem. This results in less pain and less blood loss. Newer glenoid replacements rely less on cement (albeit a small amount is used in 3 short pegs) and more on bony in growth into a central peg. Operating times have shortened from 3 hours to less than two.

I have attached three xray pictures below. These include the newest generation "short stem" with pegged glenoid implant, a more conventional humeral implant, and a typical xray showing glenohumeral osteoarthritis.

I have attached a link to a video showing early outcome with the Tornier Ascend prosthesis (1st x-ray below). Click on the link:http://www.rearmyourself.com/video/?...%20outcome.flv

or click on: http://www.rearmyourself.com/article...er-replacement

and play the video at the bottom entitled "Early Favorable Outcome using the Tornier Ascend Anatomic Total Shoulder Prosthesis." The video shows actual bony ingrowth into the peg!! We are hopeful that this biologic advance will improve the durability of the glenoid component and result in a much lower incidence of loosening over the years.

[mtomaino]

For patient attestations following anatomic total shoulder replacement at various postoperative intervals, visit this link and click on the videos:

http://www.rearmyourself.com/article...er-replacement

[mtomaino]

In the March 2011 edition of the Journal of Shoulder and Elbow Surgery, two publications provide valuable information regarding outcomes after Total shoulder replacement.

In "Patient reported activities after shoulder replacement: total and hemiarthroplasty" Dr Cofield and co-investigators from the Mayo Clinic report no difference in patient-reported activities when comparing those who had a Total with those who had a Hemi. Conventional thinking is tht Hemi allows more activities. In addition, Total shoulder replacement resulted in better motion and strength.

In "Long-term activity restricitons after shoulder arthroplasty: an international survey of experienced shoulder surgeons" 47 North American and 52 European surgeons share their opinions regarding what is allowed. Suffice it to say that the most restrictions were after Reverse arthroplasty, and for the most part, activities with a high risk of falling and repetetive demands on the arm were of concern. The article did not provide any data regarding lifting restrictions.

Both of these articles can be viewed as PDF's at this link:
http://www.rearmyourself.com/article...er-replacement

[Maryann]

As a recipient of two reverse shoulder revision replacements I am extremely
interested in all information on shoulder replacement. With a Tornier replacment in one
shoulder and a DJO in the other, I hope to see the best of both worlds! Physical therapy has been rigorous with only a little over a month since my surgery. But determination
and attitude is the name of the game. Dr. Tomaino is the best- and not for one minute have I regretted having both my shoulders done. You are in the hands of the best.the rest
is up to you. Go for it!!!

[mtomaino]

I have attached a link to a video showing early outcome with the Tornier Ascend prosthesis (1st x-ray on my initial post). Click on the link:http://www.rearmyourself.com/video/?...%20outcome.flv

or click on: http://www.rearmyourself.com/article...er-replacement

and play the video at the bottom entitled "Early Favorable Outcome using the Tornier Ascend Anatomic Total Shoulder Prosthesis." The video shows actual bony ingrowth into the peg!! We are hopeful that this biologic advance will improve the durability of the glenoid component and result in a much lower incidence of loosening over the years.

[mtomaino]

Sorry for the delay in responding. If you have significant glenoid wear, there is now a new glenoid component available (Depuy) that allows a "build up" to allow replacement. Alternatively, there are techniques to add bone graft which would then support a pegged implant. If there is a way for you to attach x-ray images of your shoulder, I would be happy to evaluate--please make sure that your name is not on the images. I would also add that in cases of severe arthritis, there is a technique referred to as "Ream and Run" which has been popularized by Dr Matsen in Seattle. This involves smoothing off the glenoid and replacing only the "ball" --humerus.