Not Easy Being a Girl...PO Day 106

It's interesting but in every survey I scanned through there were significantly more women patients than men. One typical survey population was 558 women and 178 men. I did not come across an explanation for this disparity but wonder if the protocol for choosing the surgical candidate could explain it. The patient should be a less active person over 65 years old. Heavy labor and physically demanding sports are contraindicated for a successful and long term recovery. The patient should demonstrate a "low functional demand" for  their new shoulder. And they should be able to understand and be willing to comply with some restriction of activity for life. Also, proximal humerus fracture, one of the problems that rTSA works well for, is more common in older women who have more brittle bones. This type of fracture is seen most in young active kids and older women, in fact. These indications for surgery might be a little passé but the general idea is still that a person with this surgery needs to be conservative in physical activity post operatively.

Another indication for rTSA is a rotator cuff injury that does not lend itself to more common treatment. Rotator cuff tear arthropathy (or shoulder arthritis with a large rotator cuff tear) most often occurs in individuals over the age of 65 and is more common in women than men.

Shoulder osteoarthritis develops most often in people in their 50s and beyond. Overuse and abuse take their toll on joints and, with time, problems like osteoarthritis occur, not just in shoulders. The condition occurs more frequently in women than men and in severe cases rTSA is a possible treatment.

 Failed rotator cuff repair surgery and failed total shoulder arthroplasty are both indications for rSTA but there does not appear to be a reason those would occur more in women than in men. Tumors, pseudo paralysis, and proximal humeral malunion are also causes to consider rTSA surgery but none of those appear to be gender specific. 

Where you live does seem to be a factor in the rate of rTSA. In the Dartmouth Atlas Surgery Report it was found that the rate of all Total Shoulder Replacement  procedures varied considerably according to location. In 2005-2006 Syracuse, NY, East Long Island, NY, Los Angeles, and Pittsburg had the lowest rates and Provo, Utah, Great Falls, Nebraska, Omaha, Nebraska and Minneapolis, Mn had the highest rates of shoulder replacement surgery.

So, if you are a female over 70 living in Provo, Utah (3 cases per 1000 people) who has abused your shoulder in your younger years, developed arthritis, had a calamitous accident and shattered your proximal humerus which healed in a whomperjawed  malunion and has either chronic pain or pseudoparalysis, your chances of having  rTSA surgery are about ten times greater than a man of like age and life experience who lives in Syracuse, NY (0.3 cases per 1000).

It does seem men get all the breaks sometimes but I wouldn't trade.

http://youtu.be/plUwmfOhxeE


Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September..