““HemicapHemicap”” ResurfacingResurfacing““The ShoulderThe Shoulder””

--Early Indications, Early Indications, Techniques , ResultsTechniques , Results

AnthonyAnthony MiniaciMiniaci MD FRCSCMD FRCSCExecutive Director Sports HealthExecutive Director Sports HealthHead Section Sports MedicineHead Section Sports MedicineCleveland Clinic FoundationCleveland Clinic Foundation

Cartilage DefectsCartilage Defects

� young patients

� trauma, sports injuries

� no cure exists

� Shoulder is not a knee

� loss of function, causes pain, leads to arthritis

Osteochondral InjuriesOsteochondral Injuries--Solutions?Solutions?

Cartilage Defect-Treatment Options

� Conservative –Antiinflammatories, Physiotherapy, Glucosamine, Chondroitin, Synvisc Injections, Not Cortisone

� Lavage

� Remove loose fragment, debridement

� Microfracture, ACI, matrix+ACI, OAT, allografts

Cartilage DefectsCartilage Defects--More Questions than SolutionsMore Questions than Solutions

� Many Questions

� Does Cartilage heal or regenerate

� Symptom control

� Long term function

� How do we restore the joint surface

� The older patient

� Diffuse disease

� What do we do when these things fail!

Multiple Joint ProblemMultiple Joint Problem

� Hip-AVN

� Shoulder –focal lesions, AVN

� Foot and ankle

� Knee- failed resurfacings, AVN, OCD, early OA in young patient

HemiCAPHemiCAP ™™ implantimplant

� “HemiCAP™ fits the implant to the patient; rather than the patient to the implant”

� Multiple Geometry Options � match patient anatomy and curvature via unique instrumentation� easily reproducible

� Proven materials� Cobalt Chrome and Titanium alloy� Plasma spray coating

Animal Series Animal Series –– Group IIGroup II

End Point (12 Months) Q1 End Point (12 Months) Q1 ‘‘0303

Exposed surface of tibial articular cartilage opposed to device. Tibia; 25x, Animal 45 (20).

MFC with implant in situ. Continuous trabecular and subchondral bone interface with both the anchoring screw (Right) and the resurfacing unit (Left) was observed. Superficial zone extended across the resurfacing unit margins, providing a contiguous weight bearing surface. No evidence of subchondral cyst formation was observed.

Superficial zone over the surface of the prosthetic device. MFC; 12.6x (10).

Magnification of the superficial zoneover the center of the surface of the device. Its surface is intact and the light purple staining of the matrix indicates that proteoglycans are present. MFC; 25x (11).

“Shoulder Hemicap”

Different indications, sizes,Shapes, techniques, results

Focal LesionsFocal Lesions

Shoulder Shoulder HemicapHemicap

� Small focal defects spherical design resurfaced central areas

� As we expanded indications treating larger lesions and OA needed more curvature options

Expanded OA IndicationsExpanded OA Indications

� Young patients, high demand, severe OA

� Usually weight lifting or post capsullorraphy

� Hemi vs. TSA

� “CAP” with some glenoid resurfacing

HemicapHemicap ResurfacingResurfacing““The ShoulderThe Shoulder””

HemicapHemicap ResurfacingResurfacing““The ShoulderThe Shoulder””

What About Size !

� 30 mm limits coverage but it resurfaces the spherical portion of the head

� 35 mm will cover between 80-90% of most heads- but it gets into less spherical zones

� Need asymmetric sizing

� Advantage over Spherical resurfacing

HemicapHemicap ResurfacingResurfacing““The ShoulderThe Shoulder””

Avg. Overall Errorn=16

0.30 ± 0.08 mm

Avg. Max. Errorn=16

1.69 ± 0.32 mm

Sphere Modelling

Ovoid

1.7ximprovement

in fit over Ellipsoid

3.3x

improvement in fit over Sphere

Ellipsoid/Ovoid Comparison

Benefits of an anatomical Benefits of an anatomical reconstruction reconstruction

� Hemicap preserves anatomy

� NO issues with height or version or too much volume

� Other resurfacing options are SPHERES!

� Buchler P and Farron A used FEA to show better range of motion, bone stresses 8x lower on glenoid

Clinical Biomechanics Jan 2004

Patient PopulationPatient Population

� 62 patients, 6 institutions

� Safety and feasability evaluation

� 36 males, 26 females

� Average age 60 years(25-84)

� F/U 8 months(3-24)

� 45 pts with OA

� 8 pts with AVN

� 4 focal chondral defects

� 4 with cuff arthropathy Humeroacromial OA

� 1 with RA

Davidson PA, Lemak LJ, Litchfield RB, Siegel JA, Miniaci A

HemiCAP HemiCAP ResultsResults

� WOOS 1234/1900 to 247

� ASES 38.4-69.3

� VAS – pain- 0-100 improved from 54 to 18

� SST improved 76% ( 3.3-8.4)

� Constant score rose 51%(55-78)

� 1 failure of pain relief( glenoid OA) not resurfaced

� 95% satisfied subjectively and would have procedure again

SummarySummary

� Indications evolving

� Excellent option for symptomatic AVN or osteochondral defects

� Expanded role in lieu of hemiarthroplasty or in conjunction with glenoid resurfacing in OA in young patient

AnthonyAnthony MiniaciMiniaci MD FRCSCMD FRCSCExecutive Director Sports HealthExecutive Director Sports HealthHead Section Sports MedicineHead Section Sports MedicineCleveland Clinic FoundationCleveland Clinic Foundation