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 Presentation Transcript

  • 1. Case presentations Amit Kapoor Upper Limb Fellow
  • 2. Case 1 72 year old Retired consultant pathologist 10 month old # proximal humerus Managed conservatively Non union
  • 3. Reverse shoulder replacement aug’12
  • 4. 6/52 check
  • 5. Revision insert with pec major transfer
  • 6. Case 2 67 year old female # dislocation left shoulder feb 2012
  • 7. ORIF Feb 2012
  • 8. 2/52 f/u
  • 9. Open stabilisation mar 2012
  • 10. Redislocation, Re ORIF
  • 11. Reverse shoulder arthroplasty Oct 2012
  • 12. Closed reduction
  • 13.  Open Reduction Pec Major transfer
  • 14.  Instability most common complication, 4.7% Reoperations required in 87%, most commonly exchange of liners
  • 15.  9/57 cases of instability Within 6/12 of primary surgery All needing revision Only 3 had satisfactory results
  • 16.  6/44 prosthetic dislocation (13.6%)
  • 17. Workup Rule out infection Non infectious instabilityInadequate deltoid tensioning impingement of components insufficiency of subscapularis
  • 18. 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
  • 19. Global coaptationincrease offset Increase glenosphere diameter Neck extension beneath the poly Increase thickness of poly
  • 20. 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
  • 21. Subscapularis
  • 22.  Subscap sparing approch 4 published series Total of 50 patients No dislocations
  • 23. RSA with deltopectoral approach55 without subscap repair 65 with subscap repair 3 dislocations 2 dislocations
  • 24. Summary Multifactorial causation Increased incidence in #, revision cases Adequate tensioning of deltoid important Avoid impingement of components Subscap repair if possible