Revolutionary Joint Replacements for Upper Extremity Disorders Provide New Options for Patients

Surgeons in the Orthopedic and Arthritis Center at Brigham and Women’s Hospital are delivering dramatically improved outcomes and quality-of-life for patients with upper extremity disorders.

Revolutionary Inverse/Reverse Shoulder Prosthesis
Laurence D. Higgins, MD, Chief of the Shoulder Service, and other orthopedic specialists at Brigham and Women’s Hospital have been pioneers in developing a groundbreaking inverse/reverse prosthesis that provides pain relief and restores shoulder function in patients with markedly limited range-of-motion. Outcomes with the inverse/reverse prosthesis typically include between 130 and 140 degrees of full reflection and substantial pain relief. Dr. Higgins also offers a unique modification of this procedure using a muscle and tendon transfer (latissimus transfer) in conjunction with the new prosthesis to improve strength and provide additional function and degrees of movement.

Next Generation Wrist Replacements
Barry P. Simmons, MD, Chief of the Hand and Upper Extremity Service, offers a new prosthesis for total wrist replacement, providing an alternative to standard wrist fusion for patients with arthritic disease. Closely replicating wrist anatomy, the new prosthesis does not require the use of cement – enabling subsequent revisions without extensive tissue damage.

Early results with this prosthesis show high success and low complication rates with restoration to average functional range-of-motion of 40 degrees from extension to flexion, as well as significant pain relief. In addition, this new generation of wrist replacements also offers improved side-to-side motion compared with older generation wrist replacements.

Indications for Referral
The inverse/reverse prosthesis for shoulder replacement may be considered for patients with:

• Severe arthritis and rotator cuff tear;
• Large rotator cuff tear and pseudoparalysis (inability to lift the arm above the shoulder);
• Failed joint replacement for fractures or arthritis;
• Poor outcome after fracture of the proximal humerus.

The new prosthesis for wrist replacement may be appropriate for patients with severe, debilitating arthritis, including:

• Systemic arthritis, such as rheumatoid arthritis;
• Traumatic arthritis.

Access and Information
For more information regarding orthopedic services at Brigham and Women’s Hospital, or to refer a patient, please contact a Referral Coordinator at (617) 732-9894.