Transcript BIO-RSA 6923.264 KB - Bone and Joint Clinic of Houston, Texas
BIO-RSA
Educational Conference Bone & Joint Clinic of Houston 4/16/2012
62 yo female with right shoulder pain -Massive cuff tear on CT arthrogram -h/o RA, CABG
CT scan
Patient Example of A2 Glenoid A2
Post-Op RSA with Bone graft in Place
Basic Principles of RSA
reduce torque on the glenoid component and increase the deltoid lever arm, overcoming weak or absent rotator cuff musculature 1.
Medialization of the GHJ center of Rotation 2.
Lowering of the humerus
Issues found with a Medialized Design Inferior Scapular Notching (50-96%) Limited ROM secondary to Impingement Instability (3-6%) – Poor tissue tension/impingement Contour/Cosmesis
Increased-Offset (Lateralized) RSA
Bony autogenous bone graft harvested from the humeral head on a specifically designed baseplate with a long central peg keeps the center of rotation at the glenoid bone prosthesis interface once the bone graft has healed Metallic/Prosthetic achieved by increasing the offset of the glenosphere and/or baseplate (metallic lateralization) disadvantage of increasing torque or shear force applied to the glenoid component and potentially increasing the risk of glenoid loosening
Glenoid Morphology (Walch et al.)
Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis
Gilles Walch, MD, Roger B a d e t , MD, Aziz B o u l a h i a , MD, and A l f r e d Khoury, MD The Journal of Arthroplasty Vol. 14 No. 6 1999
A1 Walch et al.
A2 Walch et al.
B1 Walch et al.
B2 Walch et al.
C Walch et al.
BIO-RSA Technique
Baseplate
BIO-RSA Technique
BIO-RSA Technique
BIO-RSA Technique
Post-Op RSA with Bone graft in Place
Bony Increased-offset Reversed Shoulder Arthroplasty Minimizing Scapular Impingement While Maximizing Glenoid Fixation CORR 2011 Pascal Boileau MD, Gre´gory Moineau MD, Yannick Roussanne MD, Kieran O’Shea FRCSI
Boileau et al.
Prospectively followed 42 patients with rotator cuff deficient shoulder treated with BIO-RSA Clinical (ROM and Constant-Murley score), radiographic and CT assessment Minimum 2 year follow-up (24-40 months) Average Age 72 (52-86 yo) Pre-op daignosis included CTA, sequela of proximal humerus fractures, failed RTC surgery
Results
Boileau et al.
98% complete graft incorporation No graft resorption, glenoid loosening, or postoperative instability was observed Inferior scapular notching found in 19% Improved clinical scores on ROM