The technical goal of hemiarthroplasty is to recreate a patients prefracture anatomy. Can reverse shoulder arthroplasty in posttraumatic revision surgery. Shoulder hemiarthroplasty with nonprosthetic glenoid. Although humeral hemiarthroplasty can provide good results, there is some evidence that the comfort and function is less than a successful total shoulder arthroplasty. Revision to reverse shoulder arthroplasty is a feasible option in properly selected patients. Explore alternatives to total shoulder arthroplasty in younger arthritic patients and view expertly narrated video demonstrations of surgical techniques. The rehabilitation protocol for total shoulder arthroplasty tsa hemiarthroplasty hhr is based on the latest research. Shoulder and elbow surgerya title in the operative techniques seriesoffers you the stepbystep guidance you needon slap reconstruction, total shoulder arthroplasty, humerus fractures, and morefrom experts donald lee and robert neviaser.
Hemiarthroplasty was popularized by charles neer, md, 1 and represented a significant advance in shoulder arthroplasty. Attempts to solve the glenoid problem with interposed. Total shoulder arthroplastyhemiarthroplasty protocol. Part iii presents specific surgical techniques utilized during revision shoulder. This book organizes and presents the most uptodate, evidencebased. Morris md, in shoulder arthroplasty second edition, 2019. The stem and head may be used by themselves, as a hemiarthroplasty, if the natural glenoid provides a sufficient bearing surface, or in conjunction with the glenoid, as a total replacement.
The purpose of this article is to describe a reliable surgical technique using the pectoralis major tendon insertion as a reference for the determination of the humeral component height during hemiarthroplasty recon. Francis mendoza will explain when a shoulder hemiarthroplasty is recommended. It is not intended to be a substitute for special instructions from dr. A step by step approach to the ream and run is shown here. Written by the worlds foremost shoulder and elbow surgeons, this volume is the most comprehensive, current reference on shoulder and elbow arthroplasty. What are some of the indications of shoulder hemiarthroplasty. Arthroscopic and miniopen rotator cuff repair with the juggerknot soft anchor 2. While use of an axial starter reamer is needed, use of cylindrical reamers is not necessary to prepare the femoral canal. Paff, or clinical decision making regarding the pro. Femoral canal preparation use the box osteotome and canal finder for initial entry into femoral canal.
Any surgical act always implies a minimal risk of failure. Technical pitfalls of shoulder hemiarthroplasty for fracture. The mean followup period was 52 months range 1298, and the mean constant score was 59. Stepbystep, evidencebased guidance walks you through both common and unique cases youre likely to see in your practice, while tips. Shoulder hemiarthroplasty ha is indicated in patients with displaced and comminute fractures, where avascular necrosis of the humeral head seems inevitable. While enthusiasm for hemiarthroplasty has waned, especially in the setting of osteoarthritis, the painful hemiarthroplasty continues to be a frequent presenting complaint in the shoulder specialists office.
Revision to a reverse shoulder replacement is a viable salvage. The most common complications following primary hemiarthroplasty for proximal humerus fractures relates to surgical technique. Complex issues in the primary and revision setting assembles the clinical knowledge of leading orthopedic surgeons treating patients with arthritic shoulders. The definitive book on reverse shoulder arthroplasty from leading orthopaedic shoulder surgeons. Over the years, shoulder joint replacement has come to be used for many other painful conditions of the shoulder, such as different forms of arthritis. Comprehensive reverse shoulder system superior approach surgical technique. It covers followup exams, medication refills, and when to call your doctor or nurse. The jbjs has published a recent version of the technique here. It is not necessary to perform shoulder hemiarthroplasty as an emergency procedure. Therefore it is essential to focus on the diagnostictherapeutic risk factors involved in any given pathology, thus allowing a clear distinction to be made between normal routine situations and challenging conditions. Neviaser brings you up to speed with mustknow surgical techniques in todays technically demanding shoulder and elbow surgery. Accolade ii femoral hip system surgical technique previously lsp76 hipaccolade ii.
Dec 10, 2019 shoulder hemiarthroplasty is a shoulder replacement in which the damaged humeral head is replaced with a prosthetic humeral head. It is important that the surgeon is able to adduct and extend the arm toward the floor to. The purpose of this article is to describe a reliable surgical technique using the pectoralis major tendon insertion as a reference for the determination of the humeral. This protocol was adapted from the articles titled. Feb 23, 2017 surgical technique the patient is placed in the beach chair position with the head of the bed elevated 30 to 40, and the operative arm draped so that is it freely mobile fig. It wasnt until neers work in the 1950s however that shoulder arthroplasty began to truly develop. Failure to anatomically secure the tuberosities, restore the humeral height, and recreate the appropriate humeral retroversion are the most likely reasons for failure. Hemiarthroplasty for complex fourpart fracture of the proximal humerus. The book presents practical approaches to surgically managing each type of arthritis, the. In the event that the global unite system requires conversion to a reverse shoulder, it does so by implementing the reverse shoulder principles described by professor paul grammont. Surgical technique is a critical variable in the success of any arthroplasty. Complex and revision shoulder arthroplasty an evidencebased.
Shoulder hemiarthroplasty an overview sciencedirect topics. Medicolegal issues of shoulder surgery shoulderdoc. Open technique for partialthickness or small or medium fullthickness tears rotator cuff repair. The definitive book on reverse shoulder arthroplasty from leading orthopaedic shoulder. Shoulder arthroplasty is a rapidly evolving area of orthopedics focused on treating specific, painful ailments of the glenohumeral articulation. Since its introduction, this prosthesis has remained a popular implant in the management of hip fractures. There are various indications for shoulder hemiarthroplasty. Management of failed hemiarthroplasty with reverse. Shoulder replacement surgery was first performed in the united states in the 1950s to treat severe shoulder fractures. A french surgeon, paean, was the first to implant a shoulder prosthesis in 1893. Dec 10, 2019 background shoulder hemiarthroplasty is a shoulder replacement in which the broken humeral head is replaced with an artificial joint and the fractured bone is reconstructed around the artificial joint. Shoulder hemiarthroplasty for fractures of the proximal humerus. The standard approach for surgical exposure during shoulder arthroplasty is the deltopectoral approach 22, 23. Careful attention to surgical technique combined with design improvements, such as ultrashort stem implants and bonepreserving glenoid components, allows us to perform the procedure in a way much less invasive than it was ever possible, explains steven j.
Precise surgical technique is critical for success, with proper tension of capsular, muscular, and tendinous surfaces needed for stability. Superior migration of the prosthesis can still occur due to rotator. Hemiarthroplasty is a technically easier and faster procedure than total. The axial starter reamer is used with the thandle to open the femoral canal and to aid in determining the orientation of the femoral axis. Advantage shoulder, depuy orthopaedics, warsaw, in are available but may be difficult to use. The univers cuff arthropathy humeral head system is intended for hemiarthroplasty applications when treating endstage rotator cuff arthropathy and reverse shoulder arthroplasty is not indicated.
Stepbystep, evidencebased guidance walks you through both common and unique cases youre likely to see in your practice, while. Knee arthroplasty master techniques in orthopaedic surgery. Surgical technique prepare acetabulum if acetabular reconstruction is required, prepare the acetabulum using the surgical technique for the intended acetabular component. Innovative bonepreserving approaches to managing shoulder.
The objective of this article is to describe the surgical technique for revising a shoulder hemiarthroplasty into a reverse prosthesis. Shoulder arthroplasty is a complex procedure that is becoming increasingly more. Shoulder arthroplasty and millions of other books are available for amazon kindle. A humeral hemiarthroplasty is not the same as a ream and run. Access discussions of debates on total shoulder arthroplasty versus hemiarthroplasty. Background shoulder hemiarthroplasty is a shoulder replacement in which the broken humeral head is replaced with an artificial joint and the fractured bone is reconstructed around the artificial joint. Shoulder hemiarthroplasty physical therapy protocol phase i. The surgeon should be well acquainted with the anatomy of the shoulder and the surgical technique for the implant chosen. Despite advances in implant technology and surgical technique, the longterm results of total glenohumeral arthroplasty can be compromised by delayed loosening of the glenoid component, fragmentation, wear, and instability. Operative techniques in shoulder and elbow surgery contains the chapters on the shoulder and elbow from sam w. Immediate motion weeks 0 to 8 goals allow early healing of capsule increase passive range of motion decrease shoulder pain retard muscular atrophy and prevent rotator cuff inhibition brace discontinue use after six to eight weeks unless otherwise advised by dr. The risk of prosthetic failure continues for the duration of the life of the patient after total shoulder arthroplasty. Sometimes, surgeons make the decision between a total shoulder replacement and a hemiarthroplasty in the operating room at the time of the surgery. Success in shoulder arthroplasty surgery is not necessarily dependent only on the principle of construction of a prosthetic device nor the way.
Problems with prosthetic glenoid components are loosening and wear. Failed shoulder arthroplasty and failed internal fixation in fractures of the proximal. May 29, 2016 rehabilitation for total shoulder replacement part i. Then the patients took the book in their hand, moved back to the original. Therefore it is essential to focus on the diagnostictherapeutic risk factors involved in any given pathology, thus allowing a clear distinction to be made between. His early work with proximal humerus fractures provided him with the experience to use the same concepts to treat shoulder osteoarthritis oa. The implants are designed to articulate with the native glenoid. It is worth noting that outcomes for hemiarthroplasty. Part of the practical, highly illustrated operative techniques series, this fully revised title by drs. It is important that the surgeon is able to adduct and extend the arm toward the floor to gain access to the humeral shaft. Initial postoperative rehabilitation after tsa or shoulder hemiarthroplasty should emphasize functional mobility training to ensure independence with all adls, transfers, and ambulation and patient education on therapeutic exercises to minimize adhesion formation. Hemiarthroplasty of the shoulder wheeless textbook of. In a large multicenter study, osteonecrosis was the underlying cause in only 5% of the primary shoulder arthroplasties performed. The aim of this book chapter is to describe the methodology for approaching.
The eclipse system has been used successfully to treat primary and posttraumatic osteoarthritis, and has been supported by several clinical publications in the journal of shoulder and elbow surgery, including a thorough 9year prospective cohort that began in 2005. Oct 21, 2010 operative techniques in shoulder and elbow surgery contains the chapters on the shoulder and elbow from sam w. Shoulder hemiarthroplasty for fractures of the proximal. It was originally designed as an uncemented implant. Rotator cuff arthropathy has been historically treated with humeral hemiarthroplasty and, more recently, reverse shoulder arthroplasty. Revision to a reverse shoulder replacement is a viable salvage option in these patients. Rehabilitation for total shoulder replacement part i. The technique recognizing that a successful shoulder reconstruction is critically dependent on soft tissue balancing, this document provides a detailed guide to the techniques of tendon lengthening and capsular releases, which are integral parts of this procedure.
Stepbystep, evidencebased guidance walks you through both common and unique cases. Apr 19, 2011 shoulder hemiarthroplasty ha is indicated in patients with displaced and comminute fractures, where avascular necrosis of the humeral head seems inevitable. Preoperative planning includes obtaining scaled radiographs of the fractured and uninjured. Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain. A standard surgical technique for implantation of a reverse shoulder prosthesis via. Arthrex cuff arthropathy hemiarthroplasty technique.
The promos modular shoulder system is a hemi or total shoulder arthroplasty system intended for restoration of shoulder motion and elimination of pain. The surgical procedure should be performed under ideal circumstances. Accolade surgical protocol previously lasst adm x3 mobile bearing hip system surgical protocol for us previously lsp64 hiprestoration adm. Initial firstgeneration designs for total shoulder replacements were constrained, meaning the humeral and glenoid components were mechanically coupled around a fixed center of rotation. Shoulder hemiarthroplasty physical therapy protocol. The video journal of orthopaedics has provided a short view of the technique. There are several conditions that can lead patients to consider shoulder joint replacement surgery. Here is a technique intensive textbook of shoulder arthroplasty. Stateofthe art techniques for shoulder replacement surgery. Shoulder hemiarthroplasty with nonprosthetic glenoid arthroplasty. Hemiarthroplasty shoulder surgery understanding your treatment plan this handout explains care after your shoulder surgery while you are in the hospital, and also details care issues while you recover at home. Elrod, in acute care handbook for physical therapists fourth edition, 2014. Proximal humeral fractures were managed with primary hemiarthroplasty in 57 patients, 53 women 93% and 4 men 7% aged 5187 years mean 72. Indications the therapeutic goals of implanting an anatomical total shoulder prosthesis are to reduce pain andor bring about a functional improvement of the shoulder.
Arthroscopic technique for partialthickness or small or medium fullthickness tears open repair of rotator. The exposure and the humeral side of the arthroplasty. The ream and run article in techniques in shoulder and elbow surgery 101. A trauma hemiarthroplasty system combined with good surgical technique can ensure tuberosity fixation and subsequent union. Hemiarthroplasty for fracture neer type neer developed a foursegment classification system, which remains the standard for the evaluation and treatment of these injuries. A displaced fragment is defined as one with displacement of more than 1 cm or angulation of more than 45 degrees fig. The use of shoulder hemiarthroplasty and humeral head. The distribution of shoulder replacement among surgeons and hospitals is significantly different than that of hip or knee replacement. Ballista percutaneous screw placement system surgical. Hemiarthroplasty for fracture neer type shoulderdoc. Conversion of failed hemiarthroplasty to reverse total.
Description a surgical procedure in which the humeral articular surface is replaced without attention to the glenoid side of the joint. Written by experts from leading institutions around the world, this superbly illustrated volume focuses on mastery of operative techniques and also. Although humeral head osteonecrosis is rare, it is the most common nontraumatic indication for shoulder hemiarthroplasty in our practice. The book provides stateoftheart information on implant design and detailed guidelinesincluding treatment algorithmson specific arthroplasty procedures for arthritis, fractures, chronic dislocations, and other disorders. Technical pitfalls of shoulder hemiarthroplasty for. Tornier first introduced the key principles for anatomic shoulder reconstruction. Wiesels operative techniques in orthopaedic surgery and provides fullcolor, stepbystep explanations of all operative procedures. Thompson hemi hip stem surgical technique depuy synthes 1 introduction the thompson hemiarthroplasty was first reported in the mainstream orthopaedic literature in 1954. The actual post surgical physical therapy management must be based on the surgical approach, physical examfindings, individual progress, andor the presence of postoperative complications. Patients that undergo shoulder hemiarthroplasty may have persistent symptoms or develop new symptoms secondary to glenoid erosions andor shoulder instability, mainly pain and limited mobility. Here is a technique intensive textbook of shoulder arthroplasty detailing how to handle all relevant aspects of shoulder replacement surgery.