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Indications for Reverse Total Shoulder Arthroplasty

February 24, 2016

Contributors: Mark Edward Frankel, MD

Reverse total shoulder arthroplasty (RSA) was developed as a salvage procedure, but is now used in the primary treatment of a number of conditions. RSA can be used to treat conditions that disrupt Matsen’s center line, and this concept is illustrated and discussed. The restoration of the rotation point of the humeral head back towards the center line after RSA is illustrated. The surgical technique begins with a standard humeral head cut. Then the glenoid surface is prepared, the glenosphere baseplate is implanted, and the glenosphere is applied and fixed to the baseplate. The humeral component is placed, and the joint is reduced to ensure that adequate tension has been restored to the shoulder. The next case demonstrates RSA for eccentric osteoarthritis and glenoid bone loss. The possible need to alter the version of the baseplate and the “spine line” is discussed and illustrated. Bone graft can be applied for additional support. A technique is demonstrated with considerable bone loss, and the baseplate is implanted over a humeral head bone graft. Another case demonstrates RSA for acute proximal humerus fracture. Problems with hemiarthroplasty are discussed. Repair of the tuberosities following implantation of the prosthesis proceeds according to the Black and Tan technique, as described by Dr. Jonathan C. Levy. The technique begins with tag sutures being placed and removal of the humeral head piece. Sutures and fiber tape that will secure the greater tuberosity are placed. The glenosphere is placed and the humerus is reamed. Holes for the sutures are drilled in the humerus, and a cement restrictor is placed. The humeral implant is inserted after cement and morselized bone graft are placed, and the polyethylene liner is positioned and impacted into the implant. The shoulder is reduced and the sutures reduce the tuberosities. All sutures and the fiber tape are fixed, and the shoulder is taken through a range of motion.

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