Convertibilité. Ph. Valenti. Paris Shoulder Unit Clinique Bizet (Paris, France)

Transcription

1 Convertibilité Ph. Valenti Paris Shoulder Unit Clinique Bizet (Paris, France)

2 Disclosures Arthroplasty Consultant : FH orthopaedics receive royalties Arthroscopy Consultant : Zimmer Biomet Arthrex

3 In Last two decades Number of arthroplasty has increased ATSA for osteoartrhitis HSA for complex fracture So the rate of failure has increased!!! RSA is one of option for older patient

4 Failure of HSA for fracture Malunion Nonunion Osteolysis malposition Subsidence Boileau P, (2002) J Shoulder Elbow Surg 11: Demirhan M, (2003). J Orthop Trauma 17: Mighell MA, (2003) J Shoulder Elbow Surg 12: Robinson CM, (2003) J Bone Joint Surg Am 85: Survival rate: 50-80%

5 Rate of complications unconstrained shoulder arthroplasty 10% to 16% M Wirth et al JBJS(am) 1996 FU 3.5 Years 1459 prosthesis / 204 compl 14% Walch et Aequalis Group 2000 FU 3.6 Years 766 prosthesis / 93 compl 13% Boshali et al JBJS(am) 2006 FU 5 Years 2810 prosthesis / 414 compl 14,7% Chin PY et al JSES 2006 FU 5 years 431 prosthesis / 53 compl 12%

6 Unconstrained shoulder arthroplasty 10 to 16% Glenoid loosening 8% Instability GH joint 4% Periprosthetic fracture 1,5 to 3% Rotator cuff tear 1,3% Neural injury 0,8% Infection 0,7% Deltoid muscle dysfunction 0,1% Complications are associated

7 Glenoid loosening Revision Difficult challenge!!! 1. Glenoid bone loss 2. Massive RCT Recommendation: RSA Glenoid bone reconstruction (special revision implant) Flury MP, (2011) Int Orthop 35(1):53 60 Ortmaier R, (2013) Int Orthop 37(1):67 75 Kany J et Al ( 2014 ) Int Orthop

8 Glenoid bone defect is always underestimated!!

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10 Long Stem / Cement Revision: difficult challenge!!! Sarcophage technique Humeral shaft fracture incidence 20 à 24% Van Thiel GS, (2011) J Shoulder Elbow Surg 20(8): Wall B, (2007) J Bone Joint Surg Am 89: Gohlke F, (2007) Orthop Traumatol 19: Sperling JW, (2005). J Shoulder Elbow Surg 14:

11 Bipolar prosthesis «madreporic» corindonage

12 Long stem Cerclage cement Iliac creast B graft

13 Hypothesis 2003 With the help of a platform system less demanding surgery less time consuming less complications therefore quicker healing

14 Platform system

15 2003 Arrow platform system Same Humeral Stem Common STEM Fracture HSA Hemiarthroplasty (Fracture) Total SA (Arthrosis Good cuff) Good cuff RSA ++

16 Retrospective multicentric study 2008 to 2012 Material and Methods 3 surgeons (D Katz, J Kany, Ph Valenti) 537 anatomic arthroplasty N=30 revisions (4,6%) 5 Hemi 13 TSA CG (cemented) 12 TSA MB (non cemented)

17 5 ATSA CG «switched» to ATSA MB 25 (5 hemi, 8 ATSA CG, 12 ATSA MB) «switched» to RSA

18 Combined +++ Locked posterior dislocation 17% Subsidence 13% Glenoid loosening 22% Locked anterior dislocation 4% Subscap tear 9% RCT 35%

19 Clinical outcome Mean FU 24 months (>12) Preop postop Constant score Pain 3,80 10,68 ADL 7,31 10,32 Flexion ER 18,75 23 IR 5 5,79 Strength 3,44 5,53

20 30 revisions 3 cases (10%): we had to put lower the humeral stem no enough SA to reduce the RSA We didn t change any MB No revision for cementless glenoid loosening No operative complication No instability (anatomical retroversion accepted )

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22 16 m FU Pain AAE 90 resorption of GT failure of the cuff!!!

23 RSA without removing the stem

24 O One year FU

25 Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design Karl Wieser MD, Paul Borbas MD, Eugene T. Ek MBBS, PhD, Dominik C. Meyer MD, Christian Gerber MD, FRCS Clin Orthop Relat Res (2015) 473: Retrospective review 56 cases Conversion of 48 HA + 8 ATSA to RSA 13 without exchange Stem / 43 change stem Mean FU 32 months(12-83) n=45 Group 1: 13 without exchange Group 2: 32 with exchange humeral stem

26 Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design Karl Wieser MD, Paul Borbas MD, Eugene T. Ek MBBS, PhD, Dominik C. Meyer MD, Christian Gerber MD, FRCS Clin Orthop Relat Res (2015) 473: Group 1 N=13 No exchange stem Group 2 n=32 Exchange stem Blood loss 485 ml 831ml Operation time IO complications 8% 30% Reoperations 8% 14%

27 Anterior dislocation Subscapularis rupture Anatomic MB

28 Functionnal outcomes are similar authors cases Constant pain AAE ER Castagna et al 2013 Wieser et Al 2015 Kany et al Our serie has a better Constant score 5 TSA CG revised with a TSA MB Constant 70 AAE 149

29 Conclusion #1 Modular system has substantial advantages A platform system : less demanding surgery less time consuming less complications

30 Conclusion #2 10% of the revision need humeral stem exchange But same functionnal outcome!!! Longer FU of Anatomic MB as revision Is mandatory to validate this option

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