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Case Presentations: Failed and Revision RSA
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Case Presentations: Failed and Revision RSA

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Amit Kapoor. Presented on 23/10/2012

Amit Kapoor. Presented on 23/10/2012

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    Case Presentations: Failed and Revision RSA Case Presentations: Failed and Revision RSA Presentation Transcript

    • Case presentations Amit Kapoor Upper Limb Fellow
    • Case 1 72 year old Retired consultant pathologist 10 month old # proximal humerus Managed conservatively Non union
    • Reverse shoulder replacement aug’12
    • 6/52 check
    • Revision insert with pec major transfer
    • Case 2 67 year old female # dislocation left shoulder feb 2012
    • ORIF Feb 2012
    • 2/52 f/u
    • Open stabilisation mar 2012
    • Redislocation, Re ORIF
    • Reverse shoulder arthroplasty Oct 2012
    • Closed reduction
    •  Open Reduction Pec Major transfer
    •  Instability most common complication, 4.7% Reoperations required in 87%, most commonly exchange of liners
    •  9/57 cases of instability Within 6/12 of primary surgery All needing revision Only 3 had satisfactory results
    •  6/44 prosthetic dislocation (13.6%)
    • Workup Rule out infection Non infectious instabilityInadequate deltoid tensioning impingement of components insufficiency of subscapularis
    • Inadequate deltoid tension Grammont ‘ Global Decoaptation’ – lack of sufficient deltoid tension forms a space between ball and socket Tension within conjoint tendon Surgeons experience Contralateral limb
    • Global coaptationincrease offset Increase glenosphere diameter Neck extension beneath the poly Increase thickness of poly
    • Impingement of components Impingement of implant with scapular neck in adductionTo reduce Component placement flush or extending beyond the inferior glenoid rim 150 downward tilt of component
    • Subscapularis
    •  Subscap sparing approch 4 published series Total of 50 patients No dislocations
    • RSA with deltopectoral approach55 without subscap repair 65 with subscap repair 3 dislocations 2 dislocations
    • Summary Multifactorial causation Increased incidence in #, revision cases Adequate tensioning of deltoid important Avoid impingement of components Subscap repair if possible