Arthroplasty for weight-bearing shoulders

Manual wheelchair use leads to a series of failed shoulder replacements: A case report and literature review

“…In contrast to our current protocol and the high MWto-electric wheelchair postoperative transition reported by Chiche et al, 29 we located only one other mention of a MWU that transitioned to a power wheelchair after a RTSA. 28 Additionally, we did not locate any report stating that this is a preoperative recommendation for some patients.…”

“…Several studies 17,23,24,29,38 now confirm that nearly one in four wheelchair‐dependent patients is at substantial risk of arthroplasty failure. The recent study of Chiche et al 29 suggests that this could likely be minimized with prospective modifications of wheelchair ambulation.…”

“…Several studies 17,23,24,29,38 now confirm that nearly one in four wheelchair‐dependent patients is at substantial risk of arthroplasty failure. The recent study of Chiche et al 29 suggests that this could likely be minimized with prospective modifications of wheelchair ambulation. In 2021, they reported on the outcomes of 13 shoulder arthroplasties (4 ATSA, 5 RTSA, 4 HemiA) in 11 patients who were chronic wheelchair users (three patients were using an electric wheelchair at the time of surgery).…”

“…For example, two studies reporting timeframes for when ambulation and transfers are allowed in MWUs after a RTSA, ATSA, or HemiA recommend that transfers should wait 8–12 weeks, and full‐strength manual propulsion should wait at least 12 weeks 16,17 . One study reported that transfers are not allowed until 4 months after RTSA, 29 which differs markedly from another where transfers were allowed at 6 weeks 25 . In view of this variability, additional research is needed to develop evidence‐based guidelines for commencing transfers and propulsion for MWUs after shoulder arthroplasty, especially with RTSA because of marked increased likelihood of the specific complication of glenoid dislodgement/loosening 24 .…”

“…In the perspective of these reports and our own experience, 28 we will not revise shoulder prostheses in MWUs until they establish the preoperative use of an electric or power‐assisted wheelchair. This approach can also be beneficial for some MWUs who are undergoing an index shoulder arthroplasty 29 . For patients who desire maintaining some manual propulsion, geared manual or power‐assisted wheelchairs could be used 1,2,30,31 .…”