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Surgical Technique for Cuff Tear Arthropathy

  • Stefano GuminaEmail author
  • Kamal I. Bohsali
  • Michael A. Wirth
Chapter

Abstract

Prior to surgical intervention, a thorough history and physical exam should be performed. Particular attention must be paid to previous or remote history of infection, prior shoulder surgery, and medical comorbidities which may contribute to a suboptimal outcome for the patient. The physical exam should focus on evaluation of the soft tissue envelope, integrity of the deltoid and teres minor, and coexisting cervical spine issues which may affect the ability to achieve pain relief and improved function after reverse shoulder arthroplasty. Appropriate imaging with plain radiographs and CT scan will allow for preoperative templating. Unless otherwise contraindicated, all anticoagulant and antiplatelet therapy should be discontinued at least 5–7 days prior to intervention. Glycemic control should be optimized to reduce the risk of postoperative infection. Perioperative IV antibiotics such as a first-generation cephalosporin or vancomycin (for patients allergic to penicillin) are administered within an hour of intervention.

The patient after induction is placed in the Semi-Fowler position on the operative table utilizing a commercially available beach chair positioner that permits unencumbered access to the shoulder. The operative extremity is prepped and draped free for the intervention.

A majority of surgeons utilize the delto-pectoral approach, though the European experience has demonstrated viability with the superior-lateral technique. Each approach has its proponents, opponents, advantages, and disadvantages.

Keywords

Cuff tear arthropathy Reverse shoulder arthroplasty Reverse shoulder arthroplasty surgical technique Lateralization of reverse shoulder arthroplasty Eccentric reaming Glenoid erosion 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Stefano Gumina
    • 1
    Email author
  • Kamal I. Bohsali
    • 2
  • Michael A. Wirth
    • 3
  1. 1.Department of Orthopaedics and TraumatologySapienza University of RomeRomeItaly
  2. 2.BOSMJacksonvilleUSA
  3. 3.Orthopaedic SurgeryUniversity of Texas HSC-San AntonioSan AntonioUSA

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