the shoulder service dept of the uthsc at san antonio ii jornadas clinico quirurgicas sobre...

The Shoulder Service Dept of the UTHSC at San Antonio

II JORNADAS CLINICO QUIRURGICAS SOBRE

PATOLOGIA DE LA EXTREMIDAD SUPERIOR

“PROTESIS DE HOMBRO Y

ROTURA CRONICA DEL

MANGUITO ROTADOR”

DR. ROCKWOOD,C.A. Jr.

UNIVERSIDAD SAN ANTONIO, TEXAS

DR. DE WILDE, L.

HOSPITAL UNIVERSITARIO DE GENT, BÉLGICA

DR. MARCO, F.

HOSPITAL SAN CARLOS, UNIV. COMPLUTENSE. MADRID

COORDINACIÓN: DR. GUERRA GARCIA, C.

HOSPITAL DE CABUEÑES, GIJON

SERVICIO DE C.O.T.

PROF. A. MURCIA MAZON

27.03.03


RESULTS OF SHOULDER RESULTS OF SHOULDER ARTHROPLASTY IN ARTHROPLASTY IN OSTEOARTHRITISOSTEOARTHRITIS

DR. ROCKWOOD, CH. A. Jr.DR. ROCKWOOD, CH. A. Jr.


SURE I DO, BUT ONLY SURE I DO, BUT ONLY FOR THE PROPER FOR THE PROPER INDICATIONS !!! INDICATIONS !!!

DO I REPLACE THE GLENOID ??DO I REPLACE THE GLENOID ??


MANY patients do well with a HA SOME patients require a

TSA

SHOULDER ARTHROPLASTY IS A

VERY SUCCESSFUL PROCEDURE


• Non concentric glenoid• When ant. or post.

glenoid is eroded 150 or more

• When HA does not produce a stable shoulder with soft tissue balance

INDICATIONS FOR INDICATIONS FOR TOTAL SHOULDER TOTAL SHOULDER

ARTHROPLASTYARTHROPLASTY


INDICATIONS FOR INDICATIONS FOR

HAHA• Fx – 3 and 4 part

• AVN

• Most cases of OA

• Most cases of RA

• Arthritis and no cuff

• Most revisions of TSA


“I used this prosthesis

during a 20 year period, until

1973, and it is still preferred by some surgeons”

Excellent results Excellent results when:when:

- good cuff- good cuff - good deltoid- good deltoid - good rehab - good rehab and a good glenoid !and a good glenoid !

NEER – 1990NEER – 1990


C.S. Neer IIC.S. Neer II“ShoulderReconstruction”“ShoulderReconstruction”

Text – W.B. Saunders – 1990Text – W.B. Saunders – 1990Chapter 3 – GlenohumeralChapter 3 – Glenohumeral

Arthroplasty p. 147-8Arthroplasty p. 147-8

NEER – 1990NEER – 1990““I continue to use the I continue to use the

humeral component humeral component alone when the alone when the

glenoid is normal.”glenoid is normal.”

REVIEW OF SHOULDER HEMIARTHROPLASTY


Pre op right shoulder


Post op glenoid reaming and HA


Post op Glenoid reaming and HAPost op Glenoid reaming and HA


NINE YEARS POST OP HEMIARTHROPLASTY


Pre Op ROM--Right


Pre Op ROM - Fraley


Pre revision ROM - Fraley


Post op TSA – Fraley


Post op TSA—Fraley


Post op revision HA to TSA6 months


Post op revision HA – TSA – 6 months


• Publications +/-30% loosening

• Radioluscent lines – 30 – 90%

• Cofield – 1983 – 2% loosening

• Torchia 1995, 89 Sh – follow up 12 years - 84% dev. radioluscent lines

- 46% dev. loosening with increase in pain

I WORRY ABOUT I WORRY ABOUT GLENOID LOOSENINGGLENOID LOOSENING


• The results of HA in many series are equal to TSA

• Modular prosthesis allows flexibility to balance the soft tissues

SUMMARYSUMMARY

HA vs TSAHA vs TSA• Ha can treat most patients with arthritis of the shoulder

• HA can treat most arthritis and cuff deficient shoulders

• HA eliminates glenoid wear concerns

• HA eliminates the high rates of glenoid loosening


MANY patients do well with a HA SOME patients require a

TSA

SUMMARYSUMMARY

SHOULDER ARTHROPLASTY IS

A VERY SUCCESSFUL PROCEDURE

the shoulder service dept of the uthsc at san antonio ii jornadas clinico quirurgicas sobre...

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