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Arthroplasty Reverse shoulder arthroplasty Approved for clinical - - PowerPoint PPT Presentation
Arthroplasty Reverse shoulder arthroplasty Approved for clinical - - PowerPoint PPT Presentation
Reverse Shoulder Arthroplasty Reverse shoulder arthroplasty Approved for clinical use in the United States in March 2004. Reverses the normal balll- socket relationship of the glenohumeral joint. As a result the center of rotation is
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Reverse shoulder arthroplasty
- Approved for clinical use in the United States in March 2004.
- Reverses the normal balll- socket relationship of the glenohumeral
joint.
- As a result the center of rotation is moved distally and medially, allowing for
more control of the shoulder muscle by the deltoid muscle (improves leverage).
- Allows for shoulder reconstruction in patients who have irreparable rotator
cuff damage, pain, and “pseudoparalysis.”
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Humeral component/stem, polyethylene insert, glenosphere, metaglene
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Pre-op evaluation
Squared off axillary scapular border Normal sloped appearance Squared off= metaglene must be placed higher. Metaglene needs to be placed as low as possible to avoid impingement of humeral component and scapula (notching). Squared off is beneficial.
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“Notching”
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Pre-op evaluation
Glenoid bone stock
- Should be at least 2cm
depth between the articular surface and the region where the glenoid narrows at the scapular neck
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Pre-op evaluation
Poor glenoid bone stock
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Pre-op evaluation
- If pre-op MRI is performed, teres minor should be
carefully evaluated and commented on.
- Patients have with functioning TM have better active
external rotation postoperatively than do patients with a nonfunctioning TM.
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Post-op evaluation
Normal positioning which change of center of articulation to allow for mechanical advantage for deltoid muscles to abduct shoulder past horizontal
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Post-op evaluation
Anterior superior displacement of humeral component because of deltoid pull
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Post-op evaluation
Lucency around metaglene (not flush)
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Post-op evaluation
Metaglene inferior screw breaches scapular cortex
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Post-op evaluation
Lucency at bone cement interface around humeral component
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Post-op evaluation
Separation of humeral stem components
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Post-op evaluation
Inferior scapular border impingement and erosion
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Post-op evaluation
Heterotopic ossification developing around arthroplasty
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Post-op evaluation
Periprosthetic fracture of humeral diaphysis