development of shoulder arthroplasty mr s bale
TRANSCRIPT
Shoulder Arthroplasty Implants - Origins and Developmennt
Mr Steve Bale FRCS(Orth)
Fellows Teaching 26/9/14
Jules Pean 1893
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
Fellows Teaching 26/9/14
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
Fellows Teaching 26/9/14
Hemiarthroplasty
Total Shoulder Replacement
Neer Prostheses
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• Monobloc prostheses
• Limited stem options
• Fixed neck angle
• No offset
Fellows Teaching 26/9/14
Shoulder Arthroplasty
Fellows Teaching 26/9/14
Good cuff
No cuff
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
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Bi-polar Arthroplasty
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Big Head
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Fellows Teaching 26/9/14
JBJS 1982; 47-51
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Fellows Teaching 26/9/14
Paul Grammont
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Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
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
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
Giles Walch
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Pascal Boileau
Fellows Teaching 26/9/14
Modularity
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Boileau JBJS Br 1997: 857 65
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
Steve Copeland
Fellows Teaching 26/9/14
Copeland Surface Replacement
Fellows Teaching 26/9/14
Copeland JBJS Br 2001: 213-21
Pyro-carbon Replacement
Fellows Teaching 26/9/14
Extended Head
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Partial Surface Replacements
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
Keeled glenoids
Pegged Glenoids
Anchor Pegs ? Metal Backed?
Pegs or Keels?
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Nuttall JSES 2007
Gartsman JSES 2005: 252-257
Anchor Pegs
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Metal Backed Glenoids
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Cofield JBJS 2008
Metal Backed Glenoids
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Metal Backed Glenoids
Fellows Teaching 26/9/14
Boileau JSES 2002: 351-9
Fellows Teaching 26/9/14
Stemmed implants – cemented /uncemented
Short Stems
Metaphyseal Bearing
Stumpy Stems
Fellows Teaching 26/9/14
Metaphyseal Bearing
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Current State with TSR
• Anatomic
• Cemented or press-fit
• All poly or poly/metal glenoids
• Revision options
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Metal Backed Glenoids
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Castagna JBJS Br 2010: 1410-5
Fellows Teaching 26/9/14
Current State with Reverse
• Less instability
• Less notching
• Revision options
Fellows Teaching 26/9/14
Instability
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Fellows Teaching 26/9/14
Notching
Fellows Teaching 26/9/14
Lateralising the Joint - Bony
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Lateralising the joint – with bone
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Lateralising the Joint – with prosthesis
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Platform
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Cuff Failure
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Going Forward
• Trabecular Metal
• Longer Pegs
• Glenoid Preparation
• Glenoid Augmentation
• Grafting options
• Planning
Fellows Teaching 26/9/14
Trabecular Metal
Fellows Teaching 26/9/14
Trabecular Metal
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Glenoid Augmentation
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3D Planning
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