reverse total shoulder arthroplasty
DESCRIPTION
Reverse Total Shoulder Arthroplasty. Reza Omid, M.D. Assistant Professor Orthopaedic Surgery Shoulder & Elbow Reconstruction Sports Medicine Keck School of Medicine of USC. Incidence of RC Tears with Osteoarthritis. 5-10%. Glenohumeral OA. Glenohumeral OA. - PowerPoint PPT PresentationTRANSCRIPT
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Reverse Total Shoulder Arthroplasty
Reza Omid, M.D.Assistant Professor Orthopaedic
SurgeryShoulder & Elbow Reconstruction
Sports MedicineKeck School of Medicine of USC
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Incidence of RC Tears with Osteoarthritis
5-10%
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Glenohumeral OA
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Glenohumeral OA
•Glenoid cartilage is typically spared anteriorly
•Wear is more pronounced posteriorly with appearance of a “biconcave glenoid”.
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Where Does Glenoid Wear Occur in RCT
Arthropathy
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Where Does Glenoid Wear Occur in RCT
Arthropathy
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REVERSE TSA
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Indications for RTSA
•Rotator cuff dysfunction•Proximal humerus fractures
•Glenoid bone loss•Revision TSA
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Reverse TSA
• Predictable outcome• Best TSA or Hemi is better
than the best reverse• Best indication is CTA• Worst indication is revision
arthroplasty• Not a good option if good
FE
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REVERSE TSA
Two Types: •Lateralized
• Initial design of the 70’s but abandoned• Frankle design recently
•Medialized • Grammont design 1991• Most common design (zimmer, tornier, depuy,
etc)
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How Does A Reverse Work?
1) Medialization/Lateralization
2) Distalization
3) Semiconstrained
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Biomechanics
1. Medialization converst the shear force to a compressive force at the baseplate/glenoid interface.
2. Distalization tensions deltoid
3. Semiconstraint nature overcomes deficient cuff
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Medialization
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Distalization
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Constraint
•Under active conditions, a mismatch of 4mm was found to produce translations (1-2mm) that most closely reproduced those observed with the original anatomy
•(Williams JOR 1996:14(6):986-993).
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Constraint
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Benefits of Lateralization
•Improved ER/IR•Improved deltoid contour•Less notching
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Benefits of Medialization
•Biomechanically superior (compression force at baseplate glenoid interface)
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Integra Reverse Shoulder System
Central Screw
Peripheral Screws
Baseplate
Glenosphere
Humeral Insert
Humeral Body
Stem
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GlenosphereGlenospheres made of CoCr
38mm diameter
Many options to varying patient anatomy, increase ROM and prevent scapular
notching– Concentric Glenosphere, 2mm Lateralized– Concentric Glenosphere, 5mm Lateralized
– 4mm Eccentric Glenosphere, 2mm Lateralized
– 4mm Eccentric Glenosphere, 5mm Lateralized
– 4mm Eccentric Glenosphere, Inferior Hooded 2mm Lateralized
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Lateralizing the C.O.R. = increased ROM, increased
internal/external, decreased scapula notching.
Eccentric = ideal baseplate positioning while allowing the
glenosphere to be position inferiorly and avoid scapular notching. Increases deltoid
tension.
Both options together + multiple humeral body heights allow us
to have only one diameter Glenosphere (38mm).
21
Glenosphere Positioning
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Baseplate and Screws
Glenoid baseplates made of Ti with Asymmatrix porous coating– 15mm length post (primary cases)– 25mm length post (revision and
bone grafting) length options– Curved back (convex) – anatomic
shape
27mm
22mm
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Central Compression Screw – 5.5mm x (20-45mm) length in 5mm
increments– Independent compression screw in various
length adds for central compression of baseplate into glenoid
Peripheral polyaxial locking screws – 4.5mm x (15-55mm) length in 5mm
increments– Anterior and Posterior are compression
screws– Superior and Inferior are compression and
then locked (Variable Angle Locking Screws)
Baseplate and Screws
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Reverse Body • Reverse Humeral Body made of Ti with
Asymmatrix porous coating• 142 degree inclination angle
– Decreases scapular notching versus a 155 degree inclination
– Increased glenoid access
• Polished medial calcar to allow for tuberosity and soft tissue suture retention.
• Asymmatrix coating allows for good secondary fixation and allows for all press fit humeral component.
• Morse taper and backup screw for body to stem connection
• 3 body height options – Small (30mm)– Standard (35mm) – Large (40mm)
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Humeral insert made of UHMWPe
– Standard - +0mm, +3mm, +6mm, +9mm– Retentive - +0mm, +3mm, +6mm, +9mm
» Retentive option provides more glenosphere coverage providing more stability yet increased chance for scapular notching.
• Humeral Stems made from Ti for press fit applications– 11 sizes (6-16mm) 1mm increments
• Humeral Stems made from CoCr for cemented applications– 5 sizes (6-14mm) 2mm increments
Humeral Poly Liners & Stems
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Surgical Technique
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Or
Humeral Preparation
142 DegreeOsteotomy
Stem Sizing & Trial
Select Small Body
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Humeral Preparation
Humeral Reaming
Humeral Body Trial and Inserter
Reamer Body Inserter
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Glenoid Preparation
Or
Baseplate Glenoid Wire Guide Glenosphere Glenoid Wire Guide
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Glenoid PreparationGlenoid Reaming
Baseplate Boss DrillingBaseplate Insertion
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Baseplate Screw Fixation5.5 Central Screw Preparation
4.5 Peripheral Screw Preparation and Locking Caps
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Peripheral Reamers and Trialing
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Glenosphere and Body/Stem Insertion
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Case
60 yo RHD s/p fall
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Challenge Case
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Extended Peg
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6 Weeks Post-Op