This document provides an overview of the pre-operative planning process for shoulder arthroplasty. It discusses 4 key steps: 1) clinical assessment using a cluster approach including history, exam, and investigations; 2) assessment of bone stock using x-rays, CT scans, and the Walch classification system; 3) assessment of rotator cuff status using CT, ultrasound, and MRIs; and 4) choosing the correct implant based on the individual patient's anatomy and bone loss classification. Advanced techniques discussed include 3D printing, patient-specific instrumentation, and custom implants to best address individual patient factors.

1. Pre Operative Planning for Shoulder
Arthroplasty
Mr Puneet Monga
Consultant Orthopaedic Shoulder Surgeon
Wrightington Hospital

2. • Step 1 Clinical Assessment
• Step 2 Assessment of Bone Stock
• Step 3 Assessment of Cuff Status
• Step 4 Choosing the correct implant

3. Step 1- Clinical Assessment
Using a Cluster approach recommended
• History
• Look Feel Move + Special Tests
• Investigations
Right Surgery for the Right Patient for the Right Diagnosis

4. Step 2- Assessment of Bone Stock

5. Assessing the Glenoid
• Xray
• CT
• 3D printing
• PSI

6. Xrays

7. CT Scans
“Go to” Investigation

8. Use Reconstructed images

9. So, how would be describe Bone loss on this Scan?

10. Walch Classification

11. Walch Classification
Centred humeral Head - No erosion

12. Walch Classification
Centred humeral Head-
Major Central glenoid erosion

13. Walch Classification
Posterior subluxed head-
No bony erosion

14. Walch Classification
Posterior Subluxed Head-
Posterior Erosion
Biconcavity

15. Walch Classification
Mono concave
Posterior wear
Retroversion at least 25 degree
and / or 70% humeral head subluxation

16. Walch Classification
25degree of retroversion “not caused by erosion”

17. Walch Classification
Any level of glenoid ante version
and / or humeral head subluxation less than 40 %

18. Version

19. Biconcavity

20. Subluxation

21. Step 3- Assessment Cuff Status

22. Para Sagittal Cuts on the CT

23. Ultrasound
Surgeon performed ultrasound

24. Pre-op Planning for Revisions
CRP, ESR, WBC
X-rays
CT
White Cell labelled Scans
Open extended cultures

25. CT Scan with Metalwork in situ

26. MR Scan with Metalwork in situ

27. Looking ahead
• 3D Printing
• PSI
• Custom implants

28. “3D Printing represents a quantum jump in defining and
assessing Orthopaedic osteology”
- Al Najjer, Monga; June2014

29. Patient Specific Instrumentation

30. Custom Jig

31. 3D Printed Custom Implant
Puneet Monga
Wrightington Hospital

32. Implantation

33. Step 4 = Choosing the right Implant
Evolution =

34. It is not “one size fits all”
-
Get to know your Options.

35. Shoulder replacements
Anatomical Reverse geometry

36. “No Object is so beautiful that, under certain
conditions, it will not look ugly”
- Oscar Wilde