“PROTESIS DE HOMBRO Y ROTURA CRONICA DEL MANGUITO ROTADOR” 27.03.03 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

RESULTS OF SHOULDER ARTHROPLASTY IN OSTEOARTHRITIS DR. ROCKWOOD, CH. A. Jr.

SURE I DO, BUT ONLY FOR THE PROPER INDICATIONS !!! DO I REPLACE THE GLENOID ?? SURE I DO, BUT ONLY FOR THE PROPER INDICATIONS !!!

MANY patients do well with a HA SOME patients require a TSA SHOULDER ARTHROPLASTY IS A VERY SUCCESSFUL PROCEDURE MANY patients do well with a HA SOME patients require a TSA

INDICATIONS FOR TOTAL SHOULDER ARTHROPLASTY 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 HA Fx – 3 and 4 part AVN Most cases of OA Most cases of RA Arthritis and no cuff Most revisions of TSA

NEER – 1990 “I used this prosthesis during a 20 year period, until 1973, and it is still preferred by some surgeons” Excellent results when: - good cuff - good deltoid - good rehab and a good glenoid !

REVIEW OF SHOULDER HEMIARTHROPLASTY NEER – 1990 “I continue to use the humeral component alone when the glenoid is normal.” C.S. Neer II “ShoulderReconstruction” Text – W.B. Saunders – 1990 Chapter 3 – Glenohumeral Arthroplasty p. 147-8

Pre op right shoulder

Post op glenoid reaming and HA

Post op Glenoid reaming and HA

NINE YEARS POST OP HEMIARTHROPLASTY

Pre Op ROM--Right

Pre Op ROM - Fraley

Pre revision ROM - Fraley

Post op TSA – Fraley

Post op TSA—Fraley

Post op revision HA to TSA 6 months

Post op revision HA – TSA – 6 months

Post op revision HA – TSA – 6 months

Post op revision HA – TSA – 6 months

I WORRY ABOUT GLENOID LOOSENING 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

SUMMARY HA vs TSA The results of HA in many series are equal to TSA Modular prosthesis allows flexibility to balance the soft tissues 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

SHOULDER ARTHROPLASTY IS A VERY SUCCESSFUL PROCEDURE SUMMARY SHOULDER ARTHROPLASTY IS A VERY SUCCESSFUL PROCEDURE MANY patients do well with a HA SOME patients require a TSA