case presentations: failed and revision rsa
DESCRIPTION
Amit Kapoor. Presented on 23/10/2012TRANSCRIPT
Case presentations
Amit KapoorUpper Limb Fellow
Case 1
72 year old Retired consultant pathologist 10 month old # proximal humerus Managed conservatively Non union
Reverse shoulder replacement aug’12
6/52 check
Revision insert with pec major transfer
Case 2
67 year old female
# dislocation left shoulder feb 2012
ORIF Feb 2012
2/52 f/u
Open stabilisation mar 2012
Redislocation, Re ORIF
Reverse shoulder arthroplasty Oct 2012
Closed reduction
Open Reduction Pec Major transfer
Instability most common complication, 4.7%
Reoperations required in 87%, most commonly exchange of liners
9/57 cases of instability Within 6/12 of primary surgery All needing revision Only 3 had satisfactory results
6/44 prosthetic dislocation (13.6%)
Workup
Rule out infection Non infectious instability
Inadequate deltoid tensioning impingement of
components
insufficiency of subscapularis
Inadequate deltoid tension
Grammont ‘ Global Decoaptation’ – lack of sufficient deltoid
tension forms a space between ball and socket
Tension within conjoint tendon Surgeons experience Contralateral limb
Global coaptation
increase offset
Increase glenosphere diameter
Neck extension beneath the poly
Increase thickness of poly
Impingement of components
Impingement of implant with scapular neck in adduction
To reduce Component placement flush or extending beyond
the inferior glenoid rim 150 downward tilt of component
Subscapularis
Subscap sparing approch 4 published series Total of 50 patients No dislocations
RSA with deltopectoral approach
55 without subscap repair 65 with subscap repair
3 dislocations 2 dislocations
Summary
Multifactorial causation
Increased incidence in #, revision cases Adequate tensioning of deltoid important Avoid impingement of components Subscap repair if possible