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Presenter: Successful TSA depends on surgical technique, patient factors

Issue: February 2018

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KOLOA, Hawaii – Success after total shoulder arthroplasty has much to do with surgical technique and patient factors, said a presenter at Orthopedics Today Hawaii 2018, here.

In his presentation, Anthony A. Romeo, MD, noted that when patients present with pain after total shoulder arthroplasty, surgeons need to identify where the pain occurs, the associated symptoms and comorbidities, if there is infection and if there is loss of function. Results will be different depending on patient age and whether the patient was on narcotics prior to surgery, according to Romeo.

Anthony A. Romeo

“There have been plenty of studies to show that those individuals on narcotics before surgery will not get the same results as the patients who are narcotic naïve before surgery,” Romeo said.

Patients who undergo early total shoulder arthroplasty have an increased risk for technical error, Romeo noted.

“I would say in standard total shoulder arthroplasty, the biggest error I see routinely is overstuffing of the joint,” he said. “For some reason, people still want to put in a head that is at least one size or more too large.”

Another form of overstuffing the joint that can lead to stiffness occurs when the stem drifts into varus, according to Romeo.

He added infection can be an issue, with late periprosthetic infections presenting months or years after the original procedure, as well as instability.

“Up to 60% of patients who come back for revision surgery will do so because their cuff has failed or become a problem for them,” Romeo said.

Romeo noted previous research identified patient factors associated with a better outcome, including American Society of Anesthesiologist class I, a shoulder problem not related to work, lower preoperative simple shoulder test score and no prior shoulder surgery.

“What was wrong with the shoulder before they had surgery is critical and our radiographic studies can help us because, again, we can predict that as there is more subluxation posteriorly and more posterior wear on the glenoid, we are going to have a higher risk of challenges and complications,” Romeo said. – by Casey Tingle

Reference:

Romeo AA. Pain after a primary shoulder arthroplasty. Presented at: Orthopedics Today Hawaii 2018; Jan. 7-11, 2018; Koloa, Hawaii.

Disclosure: Romeo reports he received other financial or material support from the Arthroscopy Association of North America, Arthrex Inc. and MLB; research support from Aesculap/B.Braun, Arthrex Inc., Histogenics, Medipost, NuTech, OrthoSpace, Smith & Nephew and Zimmer; is a board or committee member of the American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Atreon Orthopaedics and Orthopedics Today; received IP royalties from Arthex Inc.; is a paid consultant for Arthrex Inc.; is a paid presenter or speaker for Arthrex Inc.; is on the editorial or governing board for Orthopedics, Orthopedics Today, SAGE, SLACK Incorporated and Wolters Kluwer Health – Lippincott Williams & Wilkins; and receives publishing royalties, financial or material support from Saunders/Mosby-Elsevier and SLACK Incorporated.