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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
The Shoulder Service Dept of the UTHSC at San Antonio
RESULTS OF SHOULDER RESULTS OF SHOULDER ARTHROPLASTY IN ARTHROPLASTY IN OSTEOARTHRITISOSTEOARTHRITIS
DR. ROCKWOOD, CH. A. Jr.DR. ROCKWOOD, CH. A. Jr.
The Shoulder Service Dept of the UTHSC at San Antonio
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 ??
The Shoulder Service Dept of the UTHSC at San Antonio
MANY patients do well with a HA SOME patients require a
TSA
SHOULDER ARTHROPLASTY IS A
VERY SUCCESSFUL PROCEDURE
The Shoulder Service Dept of the UTHSC at San Antonio
• 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
The Shoulder Service Dept of the UTHSC at San Antonio
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
The Shoulder Service Dept of the UTHSC at San Antonio
“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
The Shoulder Service Dept of the UTHSC at San Antonio
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
The Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
Pre op right shoulder
The Shoulder Service Dept of the UTHSC at San Antonio
Post op glenoid reaming and HA
The Shoulder Service Dept of the UTHSC at San Antonio
Post op Glenoid reaming and HAPost op Glenoid reaming and HA
The Shoulder Service Dept of the UTHSC at San Antonio
NINE YEARS POST OP HEMIARTHROPLASTY
The Shoulder Service Dept of the UTHSC at San Antonio
Pre Op ROM--Right
The Shoulder Service Dept of the UTHSC at San Antonio
Pre Op ROM - Fraley
The Shoulder Service Dept of the UTHSC at San Antonio
Pre revision ROM - Fraley
The Shoulder Service Dept of the UTHSC at San Antonio
Post op TSA – Fraley
The Shoulder Service Dept of the UTHSC at San Antonio
Post op TSA—Fraley
The Shoulder Service Dept of the UTHSC at San Antonio
Post op revision HA to TSA6 months
The Shoulder Service Dept of the UTHSC at San Antonio
Post op revision HA – TSA – 6 months
The Shoulder Service Dept of the UTHSC at San Antonio
Post op revision HA – TSA – 6 months
The Shoulder Service Dept of the UTHSC at San Antonio
Post op revision HA – TSA – 6 months
The Shoulder Service Dept of the UTHSC at San Antonio
• 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 Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
The Shoulder Service Dept of the UTHSC at San Antonio
• 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
The Shoulder Service Dept of the UTHSC at San Antonio
MANY patients do well with a HA SOME patients require a
TSA
SUMMARYSUMMARY
SHOULDER ARTHROPLASTY IS
A VERY SUCCESSFUL PROCEDURE
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