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Quiz Question: 69M Chronic Shoulder Pain & Limited Mobility

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A 69-year-old man presents with chronic right shoulder pain. He states he has a limited range of motion with very loud crepitus. On physical exam his rotator cuff strength is 5/5. He has pain with both passive and active range of motion. The diagnostic ultrasound report did not demonstrate a rotator cuff tear. Why are orthopaedic surgeons choosing a total shoulder arthroplasty over hemiarthroplasty in this patient population?

A. Improved pain relief

B. Lower rate of revision surgery

C. Lower blood loss

D. Lower postoperative instability

E. Greater shoulder function

 

Answer: B. Lower rate of revision surgery. 

This is a typical patient with severe shoulder osteoarthritis with an intact rotator cuff. Both total shoulder arthroplasty and hemiarthroplasty are treatment options. However, the rate of revision surgery is higher in the hemiarthroplasty group compared to the TSA group.

In the right patient population the results of total shoulder arthroplasty (TSA) are better than those of hemiarthroplasty with respect to pain relief and function. Hemiarthroplasty might be a good option for a young patient with a preserved joint space, unaffected glenoid and isolated changes to the humeral head (i.e. AVN, humeral head fracture).

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