surgical technique shoulder resurfacing

Transcription

1 surgical technique shoulder resurfacing

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3 The CAPICA shoulder system was developed in cooperation with Prof. Dr. med. Dr. h.c. J. Jerosch, Johanna-Etienne-Krankenhaus, Neuss. Table of contents DESIGN FEATURES 2 PREOPERATIVE PLANNING 4 SURGICAL TECHNIQUE 5 IMPLANTS 11 INSTRUMENTS 12 Nota Bene: The described surgical technique is the suggested treatment for the uncomplicated procedure. In the fi nal analysis the preferred treatment is that which addresses the needs of the individual patient. Copyright Information: MUTARS, Capica, DiaLoc, ACS, AJS, Cepthar, GIS, DiaLoc, EcoFit, WinX, CarpoFit, LOAD SHIFT, implavit and implatan are registered trademarks of implantcast GmbH. The use and copy of the content of this brochure are only allowed with prior permit given by the implantcast GmbH. The Capica design is pending for patent.

4 Design features CAPICA CAPICA neutral All CAPICA implants are made of implatan Titanium alloy and are available in diameters from 38mm to 54mm (2mm increments). An additional design feature of the CAPICA prosthesis is the polished inner rim of the implant. This enables the surgeon to place sutures through the bone for the refi xation of the subscapular muscle without the risk of tearing. The ceramic coating of the articulating with TiN improves the tribological properties. To enhance the osteointegration of the CAPICA caps a pure titanium plasma coating is added to the bone contact surface. The primary fixation of the CAPICA implants was tested and was found higher than the primary fi xation of the compared prosthetic design[1]. In addition to the CAPICA implants with an enhanced central thickness the system includes the neutral CAPICA implants to treat patients without rotator cuff insuffi cencies. Indications CAPICA neutral omarthrosis without rotator cuff insufficensies CAPICA neutral resurfacing fi gure A When a mild omarthrosis without rotator cuff defect is observed the neutral CAPICA implants are used to reconstruct the articulating surface. The biomechanical circumstances are not modified or only slightly modifi ed (fi g. A; d0: distance of Tuberculum majus and Tuberculum supraglenoidale will remain). 2

5 Indications CAPICA defect arthropathy reverse shoulder system CAPICA resurfacing CAPICA (valgus) resurfacing fi gure B The CAPICA resurfacing enables the treatment of young patients with rotator cuff insuffi ciencies (fi g. B; d1: distance between Tuberculum majus and Tuberculum supraglenoidale is reduced), a reverse shoulder system is implanted regularly. To activate the deltoid muscle in a better way, the CAPICA implant with the enhanced thickness will enlarge the distance between acromion and the centre of rotation of humeral joint. This will show the similar effect as the implantation of a reverse shoulder implant (fi g. B; d2 and d3a). The great advantage is that the amount of bone resection is much smaller when compared to a reverse shoulder implant. In addition the shorter surgery time and the lower intraoperative blood loss lead to faster rehabilitation after the resurfacing procedure. In case of revision of a resurfacing implant there are still several options for treatment (i.e. arthrodesis, use of stemmed prosthesis or use of a reverse implant). The CAPICA effect can be enhanced with a possible valgisation of the implant (fi g. B; d3b). The special drill guide allows the adjustment of the valgus angle between 0 and 30. Comparative study of the primary fi xation of two different cementless humerus resurfacing implants [1] Vergleichende Analyse zweier zementloser Schulteroberfl ächenersatzsysteme ; Dipl.Ing. K.Sellenschloh, Prof.Dr. habil M.Morlock Ph.D.; Institut für Biomechanik, Technische Universität Hamburg-Harburg 3

6 Preoperative planning Please perform a planning on the preoperative x-rays while using the special CAPICA templates (fi g. C). Note: Please consider that the A/P dimensions of the humeral bone are bigger than M/L dimensions, so the planning should consider an inlay A/P positioning of the cap in order to prevent an M/L overhang of the implant. fi gure C When a rotator cuff insuffi ciency is found (fig. D) please use the special template and consider the implantation of the CAPICA implant in a valgus position Please determine the angle while using the template. fi gure D 4

7 Surgical technique fi gure 1a fi gure 1b Open the joint in the usual way, using the deltopektoral or the anterosuperioral approach. Choose the drill guide of the preoperative determined size and attach the cannulated adapter to it. Place the instrument on the articulating surface of the humerus (fi g. 1b). Align the drill guide parallel to the Collum anatomicum. This will lead to a angle of about Optionally you may lock the drill guide to the bone using the short fi xation pins. Therefore please use the pin inserter (fi g. 2a). fi gure 2a fi gure 2b For implantation of the CAPICA implant in an outstanding valgus position, please unlock the adapter, adjust the angle and lock the adapter again between 0 and 30 (fi g. 2b). It is recommended to determine the suitable valgus angle from the preoperative x-rays. Insert the 3,2mm fi xation pin through the cannulated adapter until the mark has reached the upper end of the sleeve as you can see on the left (fi g. 3a and 3b). Remove the drill guide, but leave the fi xation pin in the bone. fi gure 3a fi gure 3b 5

8 The fi xation pin is only 120mm long, so a cannulated machine is normally not needed. When you use the ic-adapters while reaming the fi xation pin will stop the reamer order to prevent over reaming. Mount the surface reamer of the correct size (also refer to the colour coding of the instruments) to the ic-adapter and start reaming carefully. The open design of the reamers allows to check the surface during reaming. Make sure that the reamer already rotates before it reaches the bone surface the fi rst time (fi g. and 4b). fi gure 4a fi gure 4b When sclerotic bone is present you should lease from time to time and clean the reamer. Note: With increased reamer depth the forces during reaming are also increased. The open design of the reamers allow the visual control of the bone chip removal during reaming. Please ream until the reamer has reach the collum and is stopped by the fi xation pin. While using the scale on the impactor (fi g. 5a) you can double check if the reaming is deep enough. Make sure that subchondrale bone is reached (fi g. 5b and 5c). fi gure 5a fi gure 5b fi gure 5c Remove the surface reamer, but leave the fi xation pin in the bone (fi g. 5c). Add the core reamer to the ic-adapter and ream over the fi xation pin until the reamer stops on the surface (fi g. 6a and 6b). 6 fi gure 6a fi gure 6b

9 Remove the core reamer and the fi xation pin (fi g. 7a) by the use of the pin extractor. The bone preparation is now finished and the trial cap can be impacted (fi g. 7b). Note: If at that point a switch to a smaller size is needed it is possible insert again the fixation pin stabilized by the use of the guide sleeve and use the smaller surface reamer in the usual manner. fi gure 7a fi gure 7b Screw the impactor into the trial cap and impact the trial until it is fully seated on the bone surface. Note: The impaction of the trial cap will fi nish the bone preparation, because the rotational fl anges of the stem will be prepared by the use of the trial caps. The fi nal implant will have additional PressFit fi xation. fi gure 8a fi gure 8b Impact the trial cap carefully until it rests completely on the surface of the bone (fi g. 8a and 8b). Unlock the impactor/extractor from the trial cap (fi g. 9a and fi g. 9b). Check the seating through the spare holes of the trial cap and perform a trial reduction of the joint. fi gure 9a fi gure 9b 7

10 After succesful trial reduction you can mount the extractor to the trial cap and remove the trial (fi g. 10a and 10b). fi gure 10a fi gure 10b The fi nal implant can now be implanted. The cap is guided by the entry cross of the central hole (fi g. 11a). Insert suture for the fi xation of the subscapularis tendon into the bone before inserting the implant. The polished inner rim will protect the suture material from damage. Use the impactor to impact the fi nal cap (fig. 11b). Make sure that the implant is seated fully on the bone surface. The gap between bone preparation and rim of the cap should be as narrow as possible (fi g. 12a and 12b). fi gure 11a fi gure 11b fi gure12a fi gure 12b 8

11 Postoperative treatment wound closure Close the subscapularis muscle with absorbable sutures. Make sure that the rotator cuff is closed completely. The deltoid muscle should be fi xed to the acromion by the use of absorbable sutures. postoperative treatment Passiv mobilisation can be started 48 hours postoperative and should be considered until the fi fth postoperative day. Active mobilisation in consideration of the pain level should start from the fi fth day until 3 weeks postoperative. The treatment of the physiotherapist should be performed according to the common regime of all prosthetic shoulder replacements. 9

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13 Implants CAPICA shoulder cap Material: implatan, TiAl 6 V 4 -forged alloy acc. to DIN ISO 5832/3 with TiN- and cpti-coating mm mm mm mm mm mm mm mm mm CAPICA shoulder cap neutral Material: implatan, TiAl 6 V 4 -forged alloy acc. to DIN ISO 5832/3 with TiN- and cpti-coating mm mm mm mm mm mm mm mm mm 11

14 Instruments CAPICA Instrument tray top tray CAPICA Instrument tray lower tray CAPICA trial cap mm mm mm mm mm mm mm mm mm CAPICA trial cap neutral mm mm mm mm mm mm mm mm mm CAPICA resurfacing reamer mm mm mm mm mm mm mm mm mm

15 Instruments CAPICA drill guide mm mm mm mm mm mm mm mm mm CAPICA adapter for drill guide (2x) ic-adapter ic-t-handle pin extractor pin inserter fi xation pins short (4x) impactor/extractor for trial cap head impactor CAPICA guide wire 3,2 x 120 mm (2x) core reamer with stop guide sleeve for resurfacing reamer

16 Your local distributor is: implantcast GmbH Lüneburger Schanze 26 D Buxtehude Germany phone: fax: internet: CAPICOPE *+E1ICCAPICOPE++* *+$$E1IC *