Retrospective multicenter study on 90 cases of reversed prosthesis comparing 3 different types of implant
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1 Retrospective multicenter study on 90 cases of reversed prosthesis comparing 3 different types of implant L Obert, E Jardin, F. Loisel, A Adam, J Uhring, S Rochet, T Lascar Orthopedic, Traumatology, Plastic and Hand surgery Unit & CIC IT 808 University Hospital of Besancon F25033 Research Unit : EA 4268 I4S IFR 133 INSERM Medical & Pharmaceutic Faculty, University of Franche Comté laurentobert@yahoo.fr
2 Conflict of Interest FX Solution, Zimmer, SBI, Synthes & Depuy, Medartis, Evolutis, Biotech & Wright, Argo Conflict of Friendship T Lascar, E Jardin, A Adam, S Rochet, N Gasse, S Rochet, D Gallinet,
3 Introduction N = 90 cases of reversed prosthesis Non traumatic cases : Eccentric arthritis (82 %) Prospective evaluation Retrospective correlation of functionnal and radiological results depending on the procedure
4 Material & Methods N= 90 patients Prospective Multicenter Evaluation 4 years 3 centers 8 surgeons 3 groups Pre OP Per OP Post OP and evaluated retrospectively by an independant surgeon AT same follow up 3 mo 6 mo 1 year 2 years QuickDash score 3 years Constant score clinical and radiologiocal complications / glenometaphyseal angle
5 Avoiding notch with gleno metaphyseal angle
6 Material & Methods 3 prosthesis 1rst generation of reversed prosthesis (4 surgeons) humeral neck angle of 155, Aequalis-Reversed Tornier BioRSA (2 surgeons) humeral neck angle of 155, lateralization of center of rotation Last generation of reversed prosthesis (3 surgeons) more vertical angle of 145, Humelock-Reversed, FX-Solutions
7 Material & Methods 81,6 % : «senior surgeon» (4 years of practice) 71 % : Deltopectoral approach Most frequent : cementless, glenosphere 36 mm Time of surgery : 116 min
8 Results 76/90 patients reviewed (15,6% of lost of FU) Age : 74 yo (52-88) Minimum Follow up of comparison : 18,4 mo Complications : 18% Satisfied or Very Satisfied : 93,4 % Aesthetic issue : 8%
9 Results Mobility and functionnal scores : No differences depending on the type of implant significantly better in the group implanted after 2012 than before 2010
10 Results : evolution of EVA EVA 9 8 7, ,26 0,53 1,23 0,64 0,89 0
11 Results : evolution of mobility ,42 99,71 131,07 133,33 121,03 120,42 121,67 126,07 108,7 111,79 Abduction ( ) ,77 62,46 22,5 24,69 30,34 34,17 22,22 26,79 Anté- élévation ( ) Rotation externe RE1 ( ) Rotation interne (points) 0
12 Results : evolution of Constant score ,66 74,17 76,82 81, ,34 54,9 39,57 51,75 52,25 54,21 56,46 Pondéré en % Total/ ,92 0
13 Results : evolution of Quick Dash Quick Dash ,99 41,58 31,55 35, ,25
14 Results The GAIN between pre & post op : Abduction : 58,6 (-10 /140 ) Flexion (AEA) : 62,6 (-15 /130 ) Constant Brut : 36,5 points (7-53,5) Constant with ponderation : 53,2 % (9,8-83,1) QuickDash : 45,3 points (0-88,6)
15 Results Gleno metaphyseal angle : 37,5 The quantity of notch were significantly lower when the angle was between 35 and 45
16 Results Notch : 35% No notch in FX group 57% in the 2 other groups Most frequent with superior approach Bio RSA : 46% partial or total lysis
17 Discussion Learning curve..! Technical modifications may improve results Even if each notch is not followed in each patient by diminution of functionnal results each surgeon has to offer to his own patient the lower risk to develop a notch 1) What do we have to explain to our patients : the gain 2) How to diminish the risk of notch
18 What is the «gain»? & the risk What did we learn? What can we explain? The gain between pre & post op : Our serie 32 series, 2214 patients Abduction 58,6 62,6 Flexion 62,6 61,4 Ext Rot 11,7 12 Constant B 36,5 37 Constant Pond 53,2 % 53% QuickDash 45,3? Complications 18% 24%
19 How to avoid notch? 145
20 Omex & reverse and Notch & Tilt
21 Avoiding notch with more vertical angle
22
23 3 mo 1 year
24 Avoiding notch with gleno metaphyseal angle You can reach the right gleno metaphyseal angle (35-45 ) In playing on the glenoid part ( tilt ) Or in the humeral part ( verticalisation) Or both FX solution
25 Avoiding notch with «big» glenosphere?
26 Conclusion What is the best way to decrease the notch? Combination of an inferior tilt, a low implantation of metaglene, a more vertical humeral angle BUT the right tension of deltoid remains up to the surgeon!
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