Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sport FRCS > Shoulder Arthroplasty for degenerative disease > Flashcards

Shoulder Arthroplasty for degenerative disease Flashcards

Total shoulder Hemi reverse shoulder shoulder arthrodesis

1
Q

What are the indications for shoulder Hemiarthroplasty?

A
  • Primary OA if
    • RC deficiency
    • glenoid bone stock inadequate
    • risk of glenoid loosening high
      • young pts
      • active labourers
  • RC arthropathy
  • Osteonecrosis wihtout glenoid involvement
  • Prox humeral fx
    • 3 part w poor bone quality
    • 4 part fx
    • head splitting fx
    • fx with significant destruction of articualr surface
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the CI for shoulder Hemiarthroplasty?

A
  • Infection
  • Neuropathic joint
  • unmotivated pt
  • coracohumeral ligament deficiency
    • provides a barrier to humeral head proximal migration in the case of RC tear
    • superior escape will occur if coracoacromial lig and RC are deificient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the outcomes for hemiarthroplasty?

A
  • In RC def shoulder
    • Status of RC is most inflential factor post op function
  • in prox humeral fx
    • provides excellent pain relief in majority
    • outcomes scores inversely proportional to pts age and time from injury to operation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What imaging is helpful prior to shoulder Hemiarthroplasty?

A
  • Xray
    • True ap
      • determine extent of OA
      • delination of fx pattern
    • axillary view
      • look for post glenoid wear
      • helps quantify displacement in fx
  • CT
    • obtain to determine glenoid version/bone stock
  • MRI
    • RC evaluation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe how you would do a shoulder Hemiarthroplasty?

A
  • Beach chair position
  • deltapectoral approach
  • cemented proethesis
    • better quality of life, rom, strength cf uncemented
  • humeral head resection
    • start osteotomy medial insertion line of supraspinatus
    • determine retroversion, implant height and size
      • 30o retroversion ideal
      • lateral fin slightly post to biceps groove
      • xs anterversion->anterior dislocation
      • xs retroversion->post dislocation
      • height
        • GT 3-5mm below top of humerus
        • distance from top of prosthesis head to upper border of pect major = 53mm
  • ​​​​​Tuberosity migration
    • **​common causes of failure **
    • attention to secure tuberosities to each other and shaft
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What would rehab be for shoulder Hemiarthroplasty?

A
  • Early passive motion until fx healed
    • duration 6-8wks
  • Strengthening excercises being once tuberosity has fully healed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the complications of shoulder Hemiarthroplasty?

A
  • Progressive Glenoid arthrosis
    • increased with young, active pts
    • tx= convesion to Total shoulder arthroplasty
  • Tuberosity malunion/displacement
    • common complx
    • tx= repositing of tuberosity with bone graft
  • Joint overstuffing
    • -> stiffness, acclerated arthritis of glenoid
  • Subcutaneous ( anterosuperior escape)
    • when RC and coracoacromial arch deficient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a total shoulder replacement?

A
  • Replacement of humeral head and glenoid resufacing
    • cemented all poly glenoid resurfacing
  • unique from TKR/THR in that
    • greater ROM in shoulder
    • success depends on of proper functioning of the soft tissues
    • glenoid is less constrained
      • leads to greater shear stresses
      • more susceptible to mechanical loosening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the factors required for a success of TSA?

A
  • Rotator cuff intact and functional
    • if RC deficient with proximal migration of humerus- glenoid resurfacing contraindicated
    • RC tear = hemi/reverse ball
  • Glenoid bone stock and version
    • if glenoid eroded down to coracoid process tehn glenoid resurfacing CI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the outcomes for TSA?

A
  • Pain relief most predictive benefit
  • reliable rom
  • good survival at 10 yrs 93%
  • good longevity with cemented & press fit humeral components
  • Worse for post -capsulorrhahpy arthropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the indications for TSA?

A
  • Pain ( ant/post ) at night & inability to do ADLs
  • Glenoid chondral wear
  • Posterior head subluxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the contraindications for TSA?

A
  • Insufficient glenoid stock
  • RC arthropathy
  • Deltoid dysfunction
  • Irreparable RC ( HEMI/Reverse shoulder preferable)
    • risk of loosening glenoid prosthesis is high ( rocking horse phenomenon)
  • Active infection
  • brachial plexus palsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the technically side of TSA?

A
  • Beachchair position
  • deltapectoral approach
    • tight shoulder may require release of upper 1/2 of pectoralis tendon to increase exposure/dislocation- pect major passes ontop of biceps tendon
  • Glenoid
    • deficiency build up with iliac bone graft
    • convex shape superior to flat
    • recreate neutral version
    • Peg design biomechanically stronger than keel
    • polyethylene backed superior to metal
    • uncemented lower rate of loosening
    • conforming vs non conforming
      • non superior
      • conforming is more stable but-> rim stress and radioluciences
      • non conforming -> > poly wear
  • Humerus
    • uncemented or cemented
    • stem should be 25-45o retroversion
    • avoid valgus, overstuffing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens if an intraopertaive fx occurs in the humeral shaft or GT?

A
  • Humeral shaft
    • take prosthesis out and use longer stem and reinforce with cerclage wire
  • GT fx
    • minimal displaced- insert standard humeral prothesis with suture fixation and autogenous cancellous bone graft of GT fx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the rehab of TSA?

A
  • Passive or active-assisted motion only during early rehab
    • risk of injury to subscapularis
  • Progress to ER isometrics
  • Limited passive ER
    • risk of tear and pull off of subscapularis tendon
    • tear -> ant shoulder instability
    • weak belly press test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the complications of TSA?

A
  • Glenoid loosening
    • 30% primaryOA
    • RF: insufficient glenoid bone stock, RC def
    • 2.9% reop rate for loosening
    • Presence of radiographic line doesn’t correalte with symptoms but progression of line does
  • Humeral stem loosening
    • most common in RA- rule ou infection
  • Subscapularis repair failure
  • Malposition of components
  • Improper soft tissue balancing
  • Iatrogenic RC injury
    • if humeral neck ostoetomy if inferior to level of RC insertion
  • Stiffness
  • Infection
    • early < 6 wks= open irrigation/debridement
    • Late >6 wks= explant iv antibiotics and reimplant
  • Neurologic injury
    • axillary n most commonly injured
    • musculocutaneous n can be injured by retractor placement under conjoint tendon
17
Q

What is a reverse shoulder replacement?

A
  • A hemisphere ball on the glenoid surfacae and artculating cup into humerus
  • considered a proceedure with high complx rate for irrepairable RC tears
18
Q

What are the indications for use fo reverse shoulder replacement?

A
  • Pseudoparalysis 2ary to irrepairable RC tear + GH arthritis
  • Incompetent coracoacromial arch- humeral escape
  • low functional demand pt
  • physiological age >70 yrs
  • suff glenoid bone stock
  • working deltoid muscle - intact axillary nerve
19
Q

What are the contraindications of reverse shoulder replacement?

A
  • Deltoid deficiency
  • bony acromion deficiency
  • glenoid osteoporosis
  • active infection
20
Q

Describe the biomechanics of reverse shoulder replacement?

A
  • The advantage of the reverse shoulder replacment is that the centre of rotation ( COR) is moved Inferiorly and medialised
  • which allows the Deltoid to act on a longer fulcrum and have more mechanical adv to substiute for the def RC muscles to provide shoulder abduction
  • allow greater by normal shoulder abduction
  • doesn’t help with ER/IR
21
Q

Describe the complications of reverse shoulder replacement?

A
  • Gerber showed a 50% complication rate, 33% reop rate & eventually 6 out of 58 reverse balls were removed
  • Dislocation
    • not related to condition of RC
  • Loosening
    • glenoid loosening most common failure
  • Instability
  • Infection
  • inferior scapular notching
    • increased risk with superiorly placed glenoid components, or insufficient inferior tilt of glenoid component on native glenoid
22
Q

What is the goal of shoulder arthrodesis? indications?

A
  • To provide a stable base for upper extremity optimising hand and elbow function
  • Stabilisation in paralytic disorders
  • brachial plexus injury
  • irrepairble deltoid, RC with arthropathy
  • salvage failed TSA
  • reconstruction post tumour
23
Q

What are the contraindications for shoulder arthrodesis?

A
  • Ipsilateral elbow arthrodesis
  • Controlateral shoulder arthrodesis
  • lack of functional scapulothoracic motion
  • charot arthropathy
  • elderly pts
  • progressive neurologic disease
24
Q

Describe the surgical technical approach to a shoulder arthrodesis?

A
  • S shaped skin incision start over scapular spine, transversing anterior over acromium and down the anterolateral aspect of forearm
  • goal - 30o abduction/30o forward flexion/30ointernal roation
  • RC is resected from prox humerus and biceps tendon tenodesed
  • Articular surface of glenoid and humeral head & undesurface of acromium decorticated
  • a 10 hole , 4.5mm pelvic recon plate is contoured over the spine of scapula, over acromium, and down shaft of humerus
  • compression screws across GH articular suface to glenoid fossa
  • plate is anchored to scapular spine w base in coracoid
25
Q

Describe the post op care after shoulder arthrodesis?

A
  • Thermoplastic orthosis applied day 1 and maintained for 6 wks
  • at 6 wks go to sling
  • at 3/12 mobilisation exercises & thoracoscapular strengthening are commenced if no signs of loosening
  • expected recovery 6-12 months
26
Q

Descibe the complications of shoulder arthrodesis

A
  • Infection
  • malunion
  • malposition
  • prominent hardwear
  • humeral shaft fx

Sport FRCS (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions