The Orthobullets Podcast CoinFlips | Shoulder & Elbow | Recurrent Shoulder Instability s/p RSA in 72M
Dec 18, 2025
In this engaging discussion, orthopaedic experts Evan Lederman, Christopher Klifto, and Peter Johnston delve into a complex case of recurrent shoulder instability in a 72-year-old post-reverse shoulder arthroplasty. They explore critical decisions between anatomic and reverse arthroplasty, emphasizing the importance of patient activity demands. The panel critiques original imaging, assesses soft-tissue roles, and debates operative strategies including innovative techniques like the yoke reconstruction. Their insights reveal essential principles for navigating challenging revisions.
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Anatomic Arthroplasty Still Preferred For Active Seniors
- For active, cuff-intact 72-year-olds, anatomic total shoulder arthroplasty remains a strong option over reverse arthroplasty.
- Reverses can limit rotation important for activities like golf despite good pain relief.
Use CT Not MRI For Instability Workup
- Get a CT for recurrent RSA instability to assess glenoid position and bony impingement.
- Avoid relying on MRI because metal artifact makes interpretation difficult.
Confirm Deltoid Function With EMG
- Before revision surgery, obtain an EMG to confirm deltoid function in repeatedly dislocating RSA patients.
- Clinical exam can be misleading; nerve dysfunction can drive recurrent instability.