whats the board answer in 2010

i will be taking the step 1 DO ortho boards and i just wanted to know what u think is the board answer nowadays in regards to should arthoplasty

i guess i need to know is is patient has RTC arthropathy, is hemiarthroplasty ever indicated. Because dont u need to RTC to prevent proximal migration.... or do u have to to do a reverse.

i think the miller lectures i had basically sai d do hemi, because reverse was so new, but those were like 5 yrs ago, so whats the answer today, ????
thanks

i will be taking the step 1 DO ortho boards and i just wanted to know what u think is the board answer nowadays in regards to should arthoplasty

i guess i need to know is is patient has RTC arthropathy, is hemiarthroplasty ever indicated. Because dont u need to RTC to prevent proximal migration.... or do u have to to do a reverse.

i think the miller lectures i had basically sai d do hemi, because reverse was so new, but those were like 5 yrs ago, so whats the answer today, ????
thanks

I would think you would need to know more details of the question/patient etc. For example a 75 y/o with cuff arthropathy is very different from a 50 y/o with cuff arthropathy. I know some surgeons are doing reverses on younger patients but a reverse is generally right now from what I've read a salvage procedure in fairly low functioning patients. This is where the surgery works the best currently from what I've read.

I like the algorithm for this in JAAOS last year: www.ncbi.nlm.nih.gov/pubmed/19571297

This article recommends a hemi for CTA in a patient >65 if active forward elevation is > 90 degrees.

Definitely an evolving topic. Neer classified pts w/ RCA as "limited goals," but there is a growing body of literature supporting increased return of functionality with RSA.

The correct answer would be "it depends." Chiefly upon the pre-op level of activity and independence of the pt. Would recommend a lit search on RSA. This would be a good start:

Management of proximal humerus fracture based on current literature
Nho SJ, et al.. J Bone Joint Surg (Am) 2007;89:44-58.

Very controversial topic you have chosen of course.

We wrote a JBJS article last year (JBJS Goldberg et al) that demonstrates that hemiarthroplasty can be a reliable option if (and only if!) preoperative forward elevation is >90 degrees (in other words, no pseudoparalysis).

Reverse TSA is certainly no longer considered experimental (as it was when questions were written 5 years ago). Any questions written on this topic today will likely be clear on whether there is a "younger" patient with reasonable motion (Hemi a reasonable choice) or an "older" patient with very poor function (Reverse TSA very reasonable choice).

Hope this helps clarify --

wnl