When do you replace the glenoid Michael A. Wirth, M.D.
Transcription
When do you replace the glenoid Michael A. Wirth, M.D.
Decision Making in Contemporary Shoulder Arthroplasty When do you replace the glenoid? Michael A. Wirth, M.D. University of Texas Health Sciences Center San Antonio Disclosure DePuy Johnson & Johnson company The author did not receive any outside funding or grants in support of the research for or preparation of this work. “Sometimes the realization that both sides are in the dark is the 1st step toward understanding.” Long-term problems, such as loss of bone stock, polyethylene wear debris, and loosening of the glenoid component have important implications… Total Shoulder Arthroplasty Versus Hemiarthroplasty Indications for Glenoid Resurfacing Allen Boyd, William Thomas, Richard Scott, Clement Sledge, & The Journal of Arthroplasty 1990 Thomas Thornhill 146 TSA & 64 HA (Neer design) RA, OA,AVN… 44 month f/u (range, 24-124) Pain relief, ROM, satisfaction better with TSA in RA ( although not statistically sig.) Shoulder Arthroplasty with or without Resurfacing of the Glenoid in Patients who have Osteoarthritis Gartsman GM. Roddey TS and Hammerman SM J Bone Joint Surg 2000 51 shoulders ( 27 TSA & 24 HA ) 35 month f/u ( range, 24 to 72 ) TSA provided significantly greater pain relief and internal rotation Pt satisfaction, function, and strength also superior but none of these differences were found to be significant Hemiarthroplasty for glenohumeral osteoarthritis: Results correlated to degree of glenoid wear Levine WN, Djurasovic M, Glasson J, Pollock RG, Flatow EL & Bigliani LU J Shoulder Elbow Surg 1997 31 shoulders 29 month f/u ( range, 14 to 72 ) 86% satisfactory when glenoid was concentric and 63% when nonconcentric Treatment of Glenohumeral Arthritis with a Hemiarthroplasty: A Minimum Five-Year Follow-up Outcome Study Wirth MA, Rockwood CA, Tapscott RS, and Southworth C J Bone Joint Surg 2006 64 shoulders (57 patients) Mean age 63 years (range, 44-78) Results were compared at 2 years and at 7.5 years All changes were small in terms of clinical importance Biconcave 20 degrees When is a hemiarthroplasty appropriate? When the glenoid cartilage is intact & concentric When there is insufficient bone to support a glenoid component When force couples are balanced in a shoulder with CTA Viable articular cartilage… Glenoid insufficiency… 6 o’clock 12 o’clock Cuff Tear Arthropathy Selection Criteria 1) 2) 3) 4) 5) >90 degrees elevation negative lag sign 4+ strength Negative Hornblower’s sign Negative lift-off Superior migration of the humeral head… “Rocking Horse effect” Still weak and Still unstable! In younger patients with an intact glenoid… When used in conjunction with a soft tissue interpositional graft in a younger patient… 6 month post op HH Glenoid At this point the literature comparing HA and TSA seems to favor the former when… Hemiarthroplasty 1) Young active patients with intact glenoid 2) Insufficient bone 3) Acute fractures 4) CTA with balanced force couples Total Shoulder A-plasty 1) Osteoarthritis 2) Rheumatoid arthritis with an intact cuff 3) Incongruency of the glenoid 4) Adequate glenoid bone stock Patient selection is key! “Do not be wedded to one method, the good surgeon, like the good golfer, has many clubs in his bag and goes to great pains to use the correct one for each shot.” Harold Boyd Thank you!