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Rehab Program After Humeral Resurfacing Hemiarthroplasty

In this case report, a physical therapist, orthopedic surgeon, and osteopathic physician work together to present the treatment of a young, active patient with severe shoulder arthritis.

The patient was a 28-year-old man who had first dislocated his shoulder at age 16 while playing football. After a shoulder dislocation that did not respond to conservative care, multiple surgical procedures were needed. The patient continued playing sports and later worked as a manual laborer. He had recurrent shoulder dislocations and developed osteoarthritis.

Various surgical procedures were done over the years. After the first injury, an arthroscopic repair of the labrum was performed. The labrum is a dense ring of fibrocartilage around the shoulder socket. It provides depth and stability for the shoulder.

During a second arthroscopic surgery, the surgeon removed a loose fragment in the joint and repaired the labrum again. At that time, there was a severely stretched ligament (part of the shoulder capsule). The surgeon tightened the ligament along the anterior shoulder capsule. There were also some early signs of joint degeneration.

Later, a work injury resulted in another shoulder dislocation. Four more surgical procedures were needed over the next few years. Pain and loss of function led to the decision to try an interpositional arthroplasty. In this operation, meniscal tissue from a donor knee was used to resurface the patient's shoulder joint. The head of the humerus was replaced with an artificial implant. The replacement of only one side of a joint is called a hemiarthroplasty.

Rehab was planned and carried out. Special consideration was given to the fact that the patient had a long history of shoulder instability and joint degeneration before the joint resurfacing operation. Release and repair of the subscapularis muscle was another important factor to consider.

The authors provided a detailed description of the rehab process and results. Immediate care with a sling was followed by physical therapy (PT). PT started at two weeks after surgery and continued for 12 weeks (three times a week). The authors gave careful thought to the when, how, and why of each part of the rehab program.

Short-term results included greatly reduced shoulder pain, increased motion, and improved function. The shoulder was stable enough to allow the patient to return to work. This was a successful treatment of a young, active adult with shoulder arthritis and instability. Using a partial shoulder replacement and biologic grafting was a good short-term option. Further follow-up is needed to determine the long-term outcomes.

References: Todd S. Ellenbecker, DPT, MS, OCS, et al. Humeral Resurfacing Hemiarthroplasty with Meniscal Allograft in a Young Patient with Glenohumeral Osteoarthritis. In Journal of Orthopaedic & Sports Physical Therapy. May 2008. Vol. 38. No. 5. Pp. 277-286.

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