Development of shoulder arthroplasty mr s bale
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Transcript of Development of shoulder arthroplasty mr s bale
Shoulder Arthroplasty Implants - Origins and Developmennt
Mr Steve Bale FRCS(Orth)
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
“.... a virtuoso of the knife, who amputates three legs and two arms in quick succession, dismantles a couple of shoulders, trepans five crania, takes out half a dozen wombs and cuts off a few testicles. He works like this for about two hours. He is dripping with blood and sweat. His feet stand in pools of blood.” Léon Daudet
Charles Neer
• Neer CS Am J Surg 1955;901-7
• Neer CS J Bone Joint Surg 1970;1090-1103
• Neer CS J Bone Joint Surg 1974;1-13
Fellows Teaching 26/9/14
• Monobloc prostheses
• Limited stem options
• Fixed neck angle
• No offset
Fellows Teaching 26/9/14
Charles Neer
Fellows Teaching 26/9/14
“In the future…the basic design of the articular surfaces should remain the same as normal anatomy. No biomechanical theory can improve on anatomical design.”
Fellows Teaching 26/9/14
Cuff deficient shoulders
Reverse Designs
Semi-constrained
Big Heads
Bipolar
Biomechanics
• Large glenosphere with no neck
• Small humeral cup covering less than half of the glenosphere
• Non-anatomomic inclination of 155 deg
• Medialise COR
• Minimises torque on glenoid component
• Recruits more deltoid fibres
• Lowers humerus tensioning deltoid
Fellows Teaching 26/9/14
Evidence
• Siveaux et al, JBJS 2004; 86B: 388-395
• Guery et al, JBJS 2006; 88A: 1742-1747
• Favard et al, Clin Orth; 2011; 469: 2469-2475
• Implant survival 90+ % 10 years
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
Hemiarthroplasty
Total Shoulder Replacement
Wirth JBJS Am 2006: 964-73
Gartsmann JBJS Am 2000
Bradley Edwards JSES 2003
Bryant JBJS Am 2005
Sandow JSES 2013
Current State with TSR
• Anatomic
• Cemented or press-fit
• All poly or poly/metal glenoids
• Revision options
Fellows Teaching 26/9/14
Current State with Reverse
• Less instability
• Less notching
• Revision options
Fellows Teaching 26/9/14
Going Forward
• Trabecular Metal
• Longer Pegs
• Glenoid Preparation
• Glenoid Augmentation
• Grafting options
• Planning
Fellows Teaching 26/9/14