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Glenohumeral Arthritis (Shoulder Arthritis)
Posted: May 1 2023 #(C102173)
A

Shoulder Pain with Massive Glenoid Bone Loss in 74F with Rheumatoid Arthritis

HPI

A 74-year-old right-hand dominant female with rheumatoid arthritis presents with R shoulder pain that progressively worsened over the last 10 years. She has pain at all times and has failed all non-operative treatments. She has very poor function and has difficulty with many activities of daily living.

PMH

Rheumatoid Arthritis

PE

Pseudoparalysis with FF/ABD to 30° and External Rotation of 5°.

Poll
1 of 14
1. In addition to the plain AP and LAT radiographs of the shoulder, would you obtain any additional imaging studies to guide?
No - AP and LAT radiographs are sufficient
1%
4/295
Yes - additional radiographic views (aXR)
0%
2/295
Yes - CT scan of the shoulder (CT)
60%
178/295
Yes - MRI scan of the shoulder (MRI)
6%
18/295
Yes - aXR + CT
8%
24/295
Yes - aXR + MRI
0%
1/295
Yes - CT + MRI
16%
49/295
Yes - aXR + CT + MRI
4%
13/295
Outside my area of expertise - best if I don't vote
2%
6/295
2. Would you use a classification system to guide your management of this patient?
No - a classification system would not help me
42%
115/269
Yes - Goutallier
4%
12/269
Yes - Hamada
6%
18/269
Yes - Seebauer
0%
0/269
Yes - Sirveaux
1%
3/269
Yes - Walch
15%
41/269
Yes - a combination of those named above
18%
51/269
Yes - other described Classification
0%
0/269
Outside of my area of expertise - best I don't answer
10%
29/269
3. How would you manage this patient?
Nonoperative
5%
14/273
Operative
90%
247/273
Outside my area of expertise - best if I don't vote
4%
12/273
4. If you choose Arthroplasty, what procedure would you perform?
I would not choose Arthroplasty
3%
9/265
Hemiarthroplasty (HA)
5%
14/265
Ream and Run (non-prosthetic glenoid)
1%
3/265
Anatomic total shoulder arthroplasty (TSA)
3%
8/265
Reverse total shoulder arthroplasty (RSA)
83%
220/265
Other
1%
5/265
Outside my area of expertise - best if I don't vote
2%
6/265
5. If you choose Reverse total shoulder arthroplasty (RSA), would you use a CT scan-based pre-operative templating software program to plan for this surgery?
I would not choose RSA
2%
7/249
No
13%
34/249
Yes
79%
198/249
Outside my area of expertise - best if I don't vote
4%
10/249
6. If you choose Reverse total shoulder arthroplasty (RSA), would you use patient-specific guides?
I would not choose RSA
3%
8/256
No
27%
70/256
Yes
64%
165/256
Outside my area of expertise - best if I don't vote
5%
13/256
7. If you choose Reverse total shoulder arthroplasty (RSA), what approach would you use?
I would not choose Arthroplasty
2%
7/258
Deltopectoral
86%
224/258
Anterosuperior
2%
6/258
Deltoid-splitting
3%
10/258
Other
0%
0/258
Outside my area of expertise - best if I don't vote
4%
11/258
8. If you choose Reverse Total Shoulder Arthroplasty (RSA), how would you manage the glenoid?
I would not choose RSA
2%
7/257
Maintain current glenoid version
1%
4/257
Eccentric reaming (Ream)
4%
12/257
Bone grafting (Graft)
7%
18/257
Augment base plate (Augment)
27%
70/257
Ream + Graft
5%
13/257
Ream + Augment
15%
39/257
Graft + Augment
12%
32/257
Ream + Graft + Augment
15%
41/257
Other
0%
2/257
Outside my area of expertise - best if I don't vote
7%
19/257
9. If you choose Reverse total shoulder arthroplasty (RSA), how would you manage the subscapularis?
I would not choose Arthroplasty
1%
4/254
Tenotomy
27%
70/254
Peel
48%
122/254
Lesser tuberosity osteotomy
16%
41/254
Outside my area of expertise - best if I don't vote
6%
17/254
10. If you choose Reverse Total Shoulder Arthroplasty (RSA), would you repair the subscapularis?
I would not choose RSA
1%
3/241
No
25%
61/241
Yes
70%
171/241
Outside my area of expertise - best if I don't vote
2%
6/241
11. If you performed the operation and obtained the construct shown WITH subscapularis repair, what would your immediate postoperative weight-bearing status be?
I would not choose RSA
2%
5/229
Non-weightbearing (NWB)
59%
137/229
Partial-weight bearing (< 5 lbs, PWB)
24%
56/229
Weight-bearing as tolerated (WBAT)
9%
22/229
Outside my area of expertise - best if I don't vote
3%
9/229
12. If you performed the operation and obtained the construct shown WITH subscapularis repair, when would you begin Passive ROM exercises such as pendulums?
I would not perform the operation shown WITH subscapularis repair
3%
7/225
Immediately
35%
80/225
1-2 weeks (7-14 days)
30%
68/225
3-4 weeks (15-28 days)
19%
44/225
5-6 weeks (29-42 days)
7%
17/225
7-8 weeks (43-56 days)
0%
2/225
> 9 weeks (>57 days)
0%
1/225
Outside of my area of expertise - best if I don't vote
2%
6/225
13. If you performed the operation and obtained the construct shown WITH subscapularis repair, when would you begin Active ROM exercises?
I would not perform the operation shown WITH subscapularis repari
3%
8/219
Immediately
5%
11/219
1-2 weeks (7-14 days)
7%
16/219
3-4 weeks (15-28 days)
21%
47/219
5-6 weeks (29-42 days)
44%
97/219
7-8 weeks (43-56 days)
12%
27/219
9-10 weeks (57-70 days)
1%
4/219
11-12 weeks (71-84 days)
1%
4/219
13 weeks or more (>84 days)
0%
0/219
Outside my area of expertise - best if I don't vote
2%
5/219
14. If you performed the operation and obtained the construct shown WITH subscapularis repair, when would you begin Strengthening exercises?
I would not perform the operation shown WITH subscapularis repair
3%
7/216
Immediately
0%
2/216
1-2 weeks (7-14 days)
1%
3/216
3-4 weeks (15-28 days)
2%
5/216
5-6 weeks (29-42 days)
20%
45/216
7-8 weeks (43-56 days)
21%
46/216
9-10 weeks (57-70 days)
10%
22/216
11-12 weeks (71-84 days)
32%
70/216
13 weeks or more (>84 days)
5%
11/216
Outside my area of expertise - best if I don't vote
2%
5/216
PROCEDURE #1 DOP: 7/26/2018

Revere Total Shoulder Arthroplasty with Patient-Specific Implants

POLL#
Surgeon's Choices
1
In addition to the plain AP and LAT radiographs of the shoulder, would you obtain any additional imaging studies to guide?
Yes - CT scan of the shoulder (CT)
4
If you choose Arthroplasty, what procedure would you perform?
Reverse total shoulder arthroplasty (RSA)
6
If you choose Reverse total shoulder arthroplasty (RSA), would you use patient-specific guides?
Yes
Intra-procedure P1
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OUTCOMES
Post-procedure P1
2 years after
Post-procedure P1
3 years after
Post-procedure P1
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