On-line CEUs

NAOT members with an active OTC credential can earn CEU credits toward recertification just by reading the “Tip of the Month” contained in each issue of the Orthotech Professional and answering a few short questions at the conclusion of the article.  Members can either answer the questions in the print version of the newsletter and return them via fax or mail to the NAOT offices, or submit answers on-line by clicking on the link at the end of each article and completing the on-line questionnaire. To receive 1 CEU (Category 2) for each article read, you must include:

-Your full name
-NAOT member number
-Email address (if applicable)
-Answers to all questions
-OTC number 

Glenosphere



History
Shoulder arthroplasty has been around for over 100 years. The first shoulder replacement was performed in 1893 by a French surgeon, Dr. Jules-Émile-Péan, for a patient suffering from the effects of skeletal tuberculosis. This replacement was created with the assistance of a dental surgeon, and the prosthesis was composed of platinum and rubber. This first procedure was performed as a salvage procedure for pain relief only. Function was not a concern.


Mockup of first shoulder arthroplasty procedure

Throughout the early 20th century, shoulder replacements were performed primarily for proximal humeral fractures. These early procedures, however, had limited effectiveness in patients. Function was significantly limited and continued pain was common.

A major breakthrough in the procedure came when a Hemi-Arthroplasty procedure was performed. This procedure involved replacing the proximal humerus, which recreated the anatomy without violating the muscular attachments. The result was greatly improved patient outcomes, both in function and pain relief. Since this procedure kept the rotator cuff intact, it improved the patient’s daily activities. This new technique also limited the number of patients requiring revision arthroplasty to correct superior humeral migration and increased glenoid wear from instability.
In the early 1970’s, surgeons began performing Total Shoulder Arthorplasty on patients with significant degenerative changes of both the shoulder ball and socket. This procedure involved resurfacing the glenoid and humeral component. Early Total Shoulder Arthroplasty procedures often failed due to glenoid loosening, and surgeons returned to performing the hemi-Arthroplasty procedure.

By the late 1970’s, surgeons developed a new technique that addressed the limitations of earlier Total Shoulder Arthroplasty procedures. The new technique was called Constrained Total Shoulder Arthroplasy – known today as Reverse Total Shoulder Arthroplasty. This concept reverses the normal anatomy of the shoulder – placing the ball in the socket’s natural place, and the socket in the ball’s natural place. This constrained design was created to limit the stress placed on the glenoid, which was the cause of earlier Total Shoulder Arthroplasty failures. We now know that this constrained design is essential treatment in patients with rotator cuff deficient degenerative joint disease.


An x-ray image of a Reverse Shoulder Arthroplasty

The newest development in shoulder replacement is the use of “Bony in Growth” technology. This new breakthrough allows the bones of the shoulder to grown into the components for fixation, which reduces the risk of bone cement interface failure and ultimately, component loosening.

Preoperative Planning for Shoulder Arthroplasty
When planning preoperatively for Total Shoulder Arthroplasty, it is important to obtain an MRI of the shoulder to evaluate to status of the rotator cuff. A patient with a complete rupture of the supraspinatus tendon is not a good candidate for a Total Shoulder Arthroplasty because the prosthesis will have a tendency to migrate superiorly, causing articulation with the acromion. In this case, a CT scan should be performed to evaluate the glenoid. If a patient has a degenerative shoulder that is also rotator cuff deficient, posterior wear on the gleniod is often increased.

Shoulder arthroplasty has become a very common treatment in recent years. In the US alone, the number of shoulder arthroplasty procedures has grown from 15,400 in 2004 to approximately 23,000 in 2008. The US Department of Health estimates that by 2020, over 63,000 shoulder arthroplasty procedures will be performed annually, making the shoulder the third most commonly replaced joint in the body. With this growing demand, researchers and manufacturers are working to produce new and improved shoulder-replacement technology to capture this market and make the treatment even more effective.