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    Real Answers to Challenging Issues in Reverse Total Shoulder Arthroplasty

    Orthopaedic surgeons routinely perform reverse total shoulder arthroplasty (rTSA) on patients with pathologies beyond the original indication for the reverse implant. With this comes the need for practical solutions to the clinical issues that can occur, such as unexplained pain, dislocation, infection, and fracture.

    At ICJR’s 7th Annual Shoulder Course, moderator Sumant G. “Butch” Krishnan, MD, sought to draw out those solutions in a panel discussion on challenging issues in rTSA. He presented several cases to an expert panel and asked for their input on what had gone wrong and what could have been done differently. Panel members included:

    • Ken Yamaguchi MD
    • Jay D. Keener MD
    • Richard J. Friedman MD FRCSC
    • Evan S. Lederman MD
    • Mark D. Lazarus MD

    Below are the cases they considered.

    RELATED: RSA for Locked Anterior Shoulder Dislocation

    Case 1: Why does this thing hurt?

    • 82-year-old right hand-dominant male patient
    • History significant for hypertension
    • BMI: 18
    • Presents with postoperative pain 6 weeks after rTSA

    Case 2: Why did this thing dislocate?

    • 70-year-old right hand-dominant male patient
    • Has undergone 3 previous shoulder surgeries, including an rTSA
    • History significant for non-insulin-dependent diabetes mellitus, hyperlipidemia, and coronary artery diseases (2 stents)
    • BMI: >50

    Case 3: Is this really infected? Now what?

    • 74-year-old right hand-dominant female patient
    • Height: 4 feet, 10 inches; weight: 305 pounds; BMI: >60
    • Has undergone 3 previous shoulder surgeries, including an rTSA
    • More than 5 cm proximal humerus bone loss
    • History significant for non-insulin-dependent diabetes mellitus, hyperlipidemia, and coronary artery diseases (2 stents)

    Case 4: Am I really on call?

    • 64-year-old right hand-dominant male patient
    • Fell 1 year prior to presentation
    • Underwent 3 months of physical therapy after the fall
    • Presents to the emergency department with arm and hand swelling
    • Active anterior elevation, 0; active external rotation, 0; active internal rotation, thigh
    • History significant for diabetes, hypertension, and hyperlipidemia

    Click the image above to hear what the expert panel had to say about these cases.