Integra_-_Reverse_Total_Shoulder_Arthroplasty.ppt

Shoulder surgery

1. Reverse Total Shoulder
Arthroplasty
Reza Omid, M.D.
Assistant Professor Orthopaedic
Surgery
Shoulder & Elbow Reconstruction
Sports Medicine
Keck School of Medicine of USC

2. Incidence of RC Tears with
Osteoarthritis
5-10%

3. Glenohumeral OA

4. Glenohumeral OA
•Glenoid cartilage is typically
spared anteriorly
•Wear is more pronounced
posteriorly with appearance of
a “biconcave glenoid”.

5. Where Does Glenoid Wear
Occur in RCT Arthropathy

6. Where Does Glenoid Wear
Occur in RCT Arthropathy

7. REVERSE TSA

8. Indications for RTSA
•Rotator cuff dysfunction
•Proximal humerus fractures
•Glenoid bone loss
•Revision TSA

9. Reverse TSA
•Predictable outcome
•Best TSA or Hemi is better
than the best reverse
•Best indication is CTA
•Worst indication is revision
arthroplasty
•Not a good option if good FE

10. REVERSE TSA
Two Types:
•Lateralized
•Initial design of the 70’s but abandoned
•Frankle design recently
•Medialized
•Grammont design 1991
•Most common design (zimmer, tornier, depuy, etc)

11. How Does A Reverse Work?
1)
Medialization/Lateralization
2) Distalization
3) Semiconstrained

12. Biomechanics
1.Medialization converst the
shear force to a compressive
force at the baseplate/glenoid
interface.
2.Distalization tensions deltoid
3.Semiconstraint nature
overcomes deficient cuff

13. Medialization

14. Distalization

15. Constraint
•Under active conditions, a
mismatch of 4mm was found
to produce translations (1-
2mm) that most closely
reproduced those observed
with the original anatomy
•(Williams JOR 1996:14(6):986-
993).

16. Constraint

17. Benefits of Lateralization
•Improved ER/IR
•Improved deltoid contour
•Less notching

18. Benefits of Medialization
•Biomechanically superior
(compression force at
baseplate glenoid interface)

19. Integra Reverse Shoulder System
Central Screw
Peripheral Screws
Baseplate
Glenosphere
Humeral Insert
Humeral Body
Stem

20. Glenosphere
Glenospheres made of CoCr
38mm diameter
Many options to varying patient anatomy,
increase ROM and prevent scapular notching
–Concentric Glenosphere, 2mm Lateralized
–Concentric Glenosphere, 5mm Lateralized
–4mm Eccentric Glenosphere, 2mm Lateralized
–4mm Eccentric Glenosphere, 5mm Lateralized
–4mm Eccentric Glenosphere, Inferior Hooded
2mm Lateralized

21. Lateralizing the C.O.R. = increased
ROM, increased internal/external,
decreased scapula notching.
Eccentric = ideal baseplate positioning
while allowing the glenosphere to
be position inferiorly and avoid
scapular notching. Increases deltoid
tension.
Both options together + multiple
humeral body heights allow us to
have only one diameter
Glenosphere (38mm).
21
Glenosphere Positioning

22. Baseplate and Screws
Glenoid baseplates made of Ti with
Asymmatrix porous coating
–15mm length post (primary cases)
–25mm length post (revision and bone
grafting) length options
–Curved back (convex) – anatomic shape
27mm
22m
m

23. Central Compression Screw
–5.5mm x (20-45mm) length in 5mm increments
–Independent compression screw in various length
adds for central compression of baseplate into
glenoid
Peripheral polyaxial locking screws
–4.5mm x (15-55mm) length in 5mm increments
–Anterior and Posterior are compression screws
–Superior and Inferior are compression and then
locked (Variable Angle Locking Screws)
Baseplate and Screws

24. Reverse Body
•Reverse Humeral Body made of Ti with
Asymmatrix porous coating
•142 degree inclination angle
–Decreases scapular notching versus a 155
degree inclination
–Increased glenoid access
•Polished medial calcar to allow for tuberosity
and soft tissue suture retention.
•Asymmatrix coating allows for good
secondary fixation and allows for all press fit
humeral component.
•Morse taper and backup screw for body to
stem connection
•3 body height options
–Small (30mm)
–Standard (35mm)
–Large (40mm)

25. Humeral insert made of UHMWPe
–Standard - +0mm, +3mm, +6mm, +9mm
–Retentive - +0mm, +3mm, +6mm, +9mm
»Retentive option provides more
glenosphere coverage providing more
stability yet increased chance for
scapular notching.
•Humeral Stems made from Ti
for press fit applications
–11 sizes (6-16mm) 1mm increments
•Humeral Stems made from CoCr
for cemented applications
–5 sizes (6-14mm) 2mm increments
Humeral Poly Liners & Stems

26. Surgical Technique

27. Or
Humeral Preparation
142 Degree
Osteotomy
Stem Sizing & Trial
Select Small Body

28. Humeral Preparation
Humeral Reaming
Humeral Body
Trial and Inserter
Reamer
Body
Inserter

29. Glenoid Preparation
Or
Baseplate Glenoid Wire Guide Glenosphere Glenoid Wire Guide

30. Glenoid Preparation
Glenoid Reaming
Baseplate Boss Drilling
Baseplate Insertion

31. Baseplate Screw Fixation
5.5 Central Screw Preparation
4.5 Peripheral Screw Preparation and Locking Caps

32. Peripheral Reamers and Trialing

33. Glenosphere and Body/Stem
Insertion
33

34. Case
60 yo RHD s/p fall

35. Challenge Case

37. Extended Peg

38. 6 Weeks Post-Op