Balgrist Shoulder Course 2017
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- Verity Woods
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1 My approach to failed hemiprosthesis Ernst Wiedemann OCM Clinic Munich
2 Consultant to Arthrex Royalties from Arthrex Consultant to Zimmer Disclosures
3 Pathways Hemi-prosthesis Anatomical prosthesis (HSA / TSA) Reverse prosthesis Resection / Arthrodesis
4 Pathways Hemi-prosthesis Anatomical prosthesis (HSA / TSA) Subscap function Reverse prosthesis Infection / Neuronal# Resection / Arthrodesis
5 Indications for revision in 50 HSA / TSA patients Arthritis (n = 26) Fracture (n = 24) Glenoid wear RC insuff. Instability PE wear Stiffness Infection RC insufficency Glenoid wear Loosening Mueller 2016
6 Indications 1. Glenoid wear 2. Infection 3. Instability 4. Tubercle / Cuff insufficiency 5. Humeral loosening -> Revision
7 m 58 a Scapular fx 1983 Glenoid Wear 12/03
8 m 58 a Revision to TSA Pain stopped after 20 years Glenoid Wear 04/11
9 Cups tend to be too big and in varus Glenoid Wear 12/03
10 No-one likes to ream the footprint Glenoid Wear
11 Outcome: Cup Revision (n = 107/1210) Danish arthroplasty register % revisions to a stemmed prosthesis HSA (n = 39) WOOS 48 <-> 75 for primary TSA (n = 31) WOOS 74 <-> 93 for primary RSA (n = 30) WOOS 68 <-> 77 for primary 41% unacceptable because of WOOS < 50 Rasmussen et al. JBJS-A 2016
12 m 68a 4-part fx Glenoid Wear 12/06 11/08
13 Glenoid Wear m 68a 4-part fx 01/10 02/09
14 m 68a 4-part fx 02/09 Glenoid Wear
15 Revision to TSA 01/12 Glenoid Wear
16 Risk factors for glenoid erosion (n = 118) Glenoid cysts (~ 3x more frequent in women) Fatty infiltration of cuff muscles Rheumatoid arthritis No influence: age, glenoid & head size Herschel et al. JSES 2016
17 Glenoid wear after HSA 5.1% (48% of revisions of HSA; Cofield 1991) Pain and stiffness Outcome: Glenoid Wear (n = 34/770) Revision Ø 18 months after HSA!! Revision in 32 / 34 cases (CS 29 -> 49) Aequalis Multicenter Study 2001
18 Revision to TSA Active ROM: Flexion 109 ERO 36 Pain VAS 2.5 CS 51 Outcome: Glenoid Wear (n = 10) Mueller 2016
19 Indications 1. Glenoid wear 2. Infection 3. Instability 4. Tubercle / Cuff insufficiency 5. Humeral loosening -> Revision
20 f 77a HSA for Boileau type 3?? Anterior Instability
21 f 77a postop anterior dislocation Anterior Instability
22 f 77a Revision, Redislocation Anterior Instability
23 Revision to RSA Anterior Instability
24 Results of pect major transfer 30 patients in 3 groups Good for cuff defect (7/11) Good for failed instability surgery (7/11) Bad for failed arthroplasty (1/8) Elhassan et al. JBJS Br 2008
25 m 77a Too low Retrotorsion 0 deg Glenoid type C 03/04 Posterior Instability
26 05/06 Rocking horse phenomenon
27 2 nd revision to TSA w/o stem revision Active ROM ABD 120 ERO 0 IRO S1 10/06 CS 48
28 Type B3/C glenoid: Primary RSA Asymmetric bone block
29 Indications 1. Glenoid wear 2. Infection 3. Instability 4. Tubercle / Cuff insufficiency 5. Humeral loosening -> Revision
30 w 68a Nonfunctional tubercles
31
32 Revision to reverse shoulder arthroplasty with retention of the humeral component 14 patients Ø 70a FU Ø 2,5a CS 9 -> 41 Lengthening 2.6 cm Werner et al. Acta Orthop 2013
33 Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design 56 patients 13 no stem exchange CS 30 -> stem exchange CS 24 -> 45 Wieser et al. CORR 2015
34 Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design 56 patients 13 no stem exchange CS 30 -> stem exchange CS 24 -> 45 Wieser et al. CORR 2015
35 w 78a Cuff insufficency 05/09
36 w 78a Cuff insufficency 01/11
37 Outcome: TSA versus RSA (n = 19) Failed stemmed HSA Follow-up Ø 41 months 4 erosions, 2 malpositions, 12 cuff failures TSA (n = 7) CS 52 RSA (n = 12) CS 31 Hartel et al. Int JSS 2015
38 Indications 1. Glenoid wear 2. Infection 3. Instability 4. Tubercles / Cuff insufficiency 5. Humeral loosening -> Revision
39 Humeral Loosening f 75 a Fracture HSA Loosening and fracture 3.5a later
40 Uncemented revision stem + plate Healing after two months Humeral Loosening
41 1584 patients 10 y f/u 96.2 % cemented 91.2 % uncemented relative risk 2.7 Risk: Posttraumatic men < 65 years Only 2% aseptic loosenings in 20 years" Cil et al. JSES 2010
42 m 54a Fracture sequelae type 1 10/04
43 m 54a Fracture sequelae type 1 08/07
44 Revision Long fracture stem New distal locking screws Additional plate 10/08
45 Revision Long fracture stem New distal locking screws Additional plate 08/09
46 08/09 Union?
47 12/13
48 12/14
49 Change to Biomet uncemented Hemi 01/15
50 Conclusion 1. Glenoid wear -> Intact Subscap? -> Secondary Glenoid +/- Bone block -> Defect Subscap? -> RSA 2. Infection -> 1 / 2 stage revision 3. Instability -> RSA 4. Cuff insufficiency -> Refixation Tubercles / Cuff RSA 5. Humeral loosening -> Revision 6. Neuronal damage -> No revision Always suspect infection! (29% of revisions; Kelly CORR 2009)
51 Thank you!
52 Cases dated Dear Prof. Dr. Wiedemann, you implanted a glenoid prosthesis ( ) and a humeral head prosthesis ( ) into my right shoulder on Sofar no problems. On TV, however, I saw the journal \ Rounds\" made by WDR. They said, that it makes sense to re-evaluate a prosthesis after 5 to 10 years. In addition, I remember you promised for such a prosthesis a life span of 8 years plus. This is why I would like to ask you: Should I see you for a checkup? Your grateful patient
53 Cases l a B t s i r g u o h S r e ld e s r u o C
54 Cases Findings Active elevation right/left 110/130 deg External rotation 40/60 deg Internal rotation L3/L5 Passive glenohumeral rotation 90/130 deg Smooth crepitus No pain!
55 Cases l a B t s i r g u o h S r e ld e s r u o C
56 Cases Explanation Waste of PE Humeral head grinds on the rim of the metal back -> Definite metallosis Probably no subscap tendon left
57 Cases Therapy? Waste of PE Humeral head grinds on the rim of the metal back -> Definite metallosis Probably no subscap tendon left - Simple change of inlay? - One-stage revision to cemented total? - Two-stage revision including bone graft to the glenoid? - Revision to reverse? -Else?
58 Cobalt 8,8 Chrome 5,22 Cases Blood test (Normal < 1 µg/l) (Normal < 0,5 µg/l)
59 Cases Therapy Patient refused revision Blood test to be repeated in one year
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Adam N. Whatley, M.D. 6550 Main St., STE. 2300 Zachary, LA 70791 Phone(225)658-1808 Fax(225)658-5299 Reverse Total Shoulder Arthroplasty with Latissimus dorsi tendon transfer Protocol: General Information:
S H O U L D E R Solutions by Tornier. Aequalistm. Pyrocarbon Humeral Head. surgical technique
S H O U L D E R Solutions by Tornier Aequalis TM Pyrocarbon humeral head SURGICAL TECHNIQUE Aequalistm Pyrocarbon Humeral Head surgical technique Aequalis TM Pyrocarbon humeral head surgical TECHNIQUE
SHOULDER RESURFACING
MGH Sports Medicine Center 175 Cambridge St., 4th floor Boston, MA 02114 http://orthodoc.aaos.org/mdprice SHOULDER RESURFACING The shoulder is a ball and socket joint that enables you to raise, twist,
Disclosure. General. Total Shoulder Arthroplasty : Results, Outcomes and Expectations 2/8/2016. Consultant for Tornier/Wright, DJO, and Conventus
Total Shoulder Arthroplasty : Results, Outcomes and Expectations Edwin E Spencer Jr MD Knoxville Orthopaedic Clinic Disclosure Consultant for Tornier/Wright, DJO, and Conventus General The literature is
Exposure EXPOSURE. Exposure - Incision. Extend old incision proximally Expose virgin quadriceps tendon
Exposure Aaron G Rosenberg MD Professor of Orthopedic Surgery Rush Medical College Chicago, Illinois Exposure - Incision Single incision can be used or modified Multiple longitudinal incisions favor the
Reverse Total Shoulder Arthroplasty Protocol
General Information: Reverse Total Shoulder Arthroplasty Protocol Reverse or Inverse Total Shoulder Arthroplasty (rtsa) is designed specifically for the treatment of glenohumeral (GH) arthritis when it
Case Report Acute Failure of a Glenoid Component in Anatomic Shoulder Arthroplasty
Case Reports in Orthopedics Volume 2016, Article ID 6208294, 5 pages http://dx.doi.org/10.1155/2016/6208294 Case Report Acute Failure of a Glenoid Component in Anatomic Shoulder Arthroplasty William E.
Arthritis of the Shoulder
Arthritis of the Shoulder In 2011, more than 50 million people in the United States reported that they had been diagnosed with some form of arthritis, according to the National Health Interview Survey.
Thursday, February 1, 2018
Thursday, February 1, 2018 7:00 AM - 8:00 AM Breakfast/Registration 8:00 AM - 10:30 AM TSA Cadaver Demos & Lab Jon Levy, MD 10:30 AM - 10:45 AM BREAK 10:45 AM - 12:45 PM rtsa Cadvaer Demos & Lab Jon Levy,
Immediate post surgical findings of soft tissue swelling, subcutaneous emphysema, and skin staples for reverse total shoulder arthroplasty.
Immediate post surgical findings of soft tissue swelling, subcutaneous emphysema, and skin staples for reverse total shoulder arthroplasty. REVERSE TOTAL SHOULDER ARTHROPLASTY WITH FRACTURED ACROMION Above:
Instability of the Shoulder after Arthroplasty*
Copyright 1993 by The Journal ofbone and Joint Surgery, Incorporated Instability of the Shoulder after Arthroplasty* BY BRUCE H. MOECKEL. M.D.t. DAVID w. ALTCHEK. M.D3. RUSSELL F. WARREN. M.D4, THOMAS
8:00-8:15 Break. 6:30-6:55 Registration and Case Discussion 6:55-7:00 Welcome and Introduction-Mazzocca
Friday February 12, 2016 Morning Session (6:30-10:00am) 6:30-6:55 Registration and Case Discussion 6:55-7:00 Welcome and Introduction-Mazzocca NESES invited Guests: International expert: Dr. Christian
Surgical. Technique. AEQUALIS Spherical Base Glenoid. Shoulder Prosthesis.
Surgical Technique Shoulder Prosthesis AEQUALIS Spherical Base Glenoid www.tornier.com CONTENTS CONTENTS 1. Subscapularis 2. Anterior capsule 3. Humeral protector 4. Inserting retractors 1. DESIGN FEATURES