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Reverse Shoulder Arthroplasty

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Reverse Shoulder Arthroplasty. Anatomy, implants, indications, complications and surgical technique

Publicado en: Salud y medicina
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Reverse Shoulder Arthroplasty

  1. 1. EVERSE SHOULDER ARTHROPLASTY Gonzalo Samitier MD, PhD HFHS Sports Medicine Fellow
  2. 2. NO INTEREST CONFLICT
  3. 3. 1917 - 2011 “… outcomes of shoulder arthroplasty were poorer when the rotator cuff was not functional" Charles S. Neer
  4. 4. Rocking horse phenomenon "Rocking horse phenomenon"
  5. 5. ROTATOR CUFF ARTHROPATHY
  6. 6. "If at first the idea is not absurd, then there is no hope for it."
  7. 7. "Get a good idea and stay with it. Dog it, and work at it until it’s done right." - Walt Disney
  8. 8. Grammont Type Reverse (France 1987) Grammont P, Trouilloud P, Laffay JP, et al. Etude et realisation d’unenouvelle prothe`sed’e`paule.Rheumatologie. 1987;39:407–418. [French]
  9. 9. EARLY RESULTS Sirveaux JBJS Br 2004 – Delta III • 80 shoulders • 44 mo f/u average • 92.5% satisfied • Elevation improved 73 to 138 • 64% scapular notching Frankle et al JBJS Aug 2005 – Encore RSP • 60 shoulders • 33 mo f/u • 95% satis • Elevation improved 55 to 105 • No scapular notching
  10. 10. Increasing Indications, complications and … Imitations
  11. 11. INDICATIONS RSA • Cuff Tear Arthropathy (CTA) • Irreparable Massive cuff tear in elderly • Osteoarthritis with cuff tear in elderly • Proximal humerus malunion/nonunion of Tuberosities • Acute proximal humerus fractures in elderly?? • Revision TSA – loose glenoid or failed cuff • Old infection (infection cleared) • Inflammatory arthritis with severe cuff deficiency • Tumor resection • Others “… symptomatic shoulder with rotator cuff non functional"
  12. 12. DESIGNS
  13. 13. PROBLEMS & COMPLICATIONS RSA • Scapular notching 35.4% • Instability 4.7% • Infection 3.8% • Glenoid loosening 3.5% • Hematoma • Acromial insufficiency fracture 1.5% • Humeral loosening 1.3% • Humerus fx 1.4% • Neuropraxia 1.2% • Glenoid disassembly Humeral disassembly • Polyethylene dislocation Matthias A. Zumstein, MDa,b, Miguel Pinedo, MDa,d, Jason Old, MD, FRCSCa,c, Pascal Boileau, MDa,* Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg (2011) 20, 146-157
  14. 14. • Problems 44% • Complications 24% • Reoperations 3.5% • Revisions after 10%. Matthias A. Zumstein, MDa,b, Miguel Pinedo, MDa,d, Jason Old, MD, FRCSCa,c, Pascal Boileau, MDa,* Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg (2011) 20, 146-157 PROBLEMS & COMPLICATIONS RSA
  15. 15. Lieven F de Wilde, Didier Poncet, Bart Middernacht, and Anders Ekelund Prosthetic overhang is the most effective way to prevent scapular conflict in a reverse total shoulder prosthesis. Acta Orthopaedica 2010; 81 (6): 719–726
  16. 16. RESULTS Smith CD, Guyver P, Bunker TD. Indications for reverse shoulder replacement: a systematic review. J Bone Joint Surg Br. 2012 May;94(5):577-83
  17. 17. Result Reverse TSA 1 Year F/U
  18. 18. Result after irreparable RCT
  19. 19. SURGICAL TECHNIQUE https://www.vumedi.com/video/reverse-total-shoulder-arthroplasty-technical- note-and-results-at-uf/
  20. 20. MADRID
  21. 21. MADRID
  22. 22. MADRID

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