18:48 PM

Anatomic TSA still relevant as use of RSA increases

Orthopedics Today reports on new research suggesting an increasing incidence of shoulder arthroplasty in the United States during the past decade may be due to expanded use and indications, as well as to an uptick in expertise with reverse shoulder arthroplasty (RSA).

Theodore A. Blaine, MD, sports medicine surgeon at HSS, who was not involved in the study, shared commentary on the clinical implications of the research.

Dr. Blaine noted that although the techniques for performing RSA and anatomic total shoulder arthroplasty (TSA) are similar, the subscapularis tendon and muscle needs to fully heal for good outcomes after an anatomic TSA, but not for RSA.

He explained, “There are some people who will do reverse replacements in a majority of people because they do not want to worry about the healing of the [subscapularis] muscle ... but I think anatomic designs are more normal. They reproduce more normal function in the shoulder with better motion.”

“I believe that if you can have an anatomic shoulder and your rotator cuff works well and heals well, then you are going to feel like it is more of a normal shoulder,” Dr. Blaine added.

Some complications are unique to RSA and not found with anatomic TSA, according to Dr. Blaine. He said these include stress fractures of the scapular spine, which can occur in 2% to 4% of RSA procedures, as well as scapular notching.

“There was some risk of a dislocation ... with reverse replacements when we first started doing them,” Dr. Blaine said. “The risk was as high as 30%. That has gone down quite a bit. The risk of dislocation now is less than 5%. But, again, that exists for reverse replacement and not as much as an issue with an anatomic replacement.”

“[There are] risks that are unique to a reverse replacement, so, because of those risks, it is not something that should be used in everybody,” Dr. Blaine noted. “If you can do an anatomic replacement, the patient will likely have more normal motion and do well.”

Read the full article at Healio.com/orthopedics.