reverse overview -姜春岩教授 3_肩关节培训班.pdf

Reverse Shoulder Arthroplasty 北京⼤学 第四临床医学院 北京积⽔潭医院运动医学中⼼肩关节外科 Chunyan Jiang MD Ph.D Professor, Shoulder Service Beijing Ji Shui Tan Hospital School of Medicine, Peking University Rotator Cuff Deficient Shoulder • Force imbalance • Superior migration of the humeral head • Deltoid retraction • Non functional joint (unstable center of rotation) TSA or HHR – contra-indicated First Reversed Prostheses 
 failed because … • Excessive constraints on the glenoid ( i.e. glenoid loosening) • Instability • Poor mobility Glenoid loosening Reversed Prosthesis – new design Paul Grammont Reversed Prosthesis – new design Designed to eliminate the risk of glenoid loosening Reverse Shoulder Arthroplasty – indications Cuff-deficient arthritis: CTA, OA, RA Cuff-deficient fractures very comminuted osteoporotic GT Revisions (failed HHR/TSR, Fx sequelae, infection) Good deltoid What is proper tension ? Feel the deltoid tension: vague ? feel the conjoined tendon: bow strings ? easiness for dislocation: is it easy ? Reverse Shoulder Arthroplasty – indications Cuff-deficient arthritis: CTA, OA, RA Cuff-deficient fractures very comminuted osteoporotic GT Revisions (failed HHR/TSR, Fx sequelae, infection) Good deltoid Age 70 yrs. ? Reverse for Fractures senior patients pre-existed cuff tears very osteoporotic and comminuted GT locked anterior dislocations Fx Treatment: Hemi vs Reverse • Gallinet D. Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res. 2009 Feb;95(1):