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καλαμάτα 2016 αρθρίτιδα ώμου

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καλαμάτα 2016 αρθρίτιδα ώμου

  1. 1. Αρθρίτιδα Ώμου Νεότερα δεδομένα Μάνος Αντωνογιαννάκης Διευθυντής Κέντρου Αρθροσκόπησης & Χειρουργικής Ώμου Διευθυντής Γ’ Ορθοπαιδικής Κλινικής Νοσοκομείου «ΥΓΕΙΑ» www.shoulder.gr
  2. 2. • Most complex joint in the body. • One of the few joints with 360 degrees rotation. • Extensive array of ligaments and muscles. Shoulder
  3. 3. The rotator cuff anterior posterior
  4. 4. Causes of Shoulder Pain • Osteoarthritis (wear and tear) • Rheumatoid arthritis • Rotator cuff tears • Shoulder impingement (bursitis and tendonitis) • Repeated dislocations or fractures • Trauma
  5. 5. Shoulder arthritis
  6. 6. Shoulder arthritis • Healthy shoulder joint • Arthritic shoulder joint
  7. 7. Shoulder arthritis
  8. 8. Symptoms and signs of Shoulder Arthritis • Pain: • Reduced/Loss of range of motion • Grinding or catching sensation • Stiffness
  9. 9. Diagnosing Shoulder Arthritis • Physical examination • Medical history review • Strength and Motion test • X-Rays • Magnetic Resonance Imaging (MRI) • Blood tests • Blood Count • Rheumatoid Factor for rheumatoid arthritis • C-Reactive Protein
  10. 10. Non-surgical Treatment Options • medication • analgesics • NSAIDs • Disease modifying med (R.A) • Corticosteroids • Τοπικές εγχύσεις • Hyalouronic acid • Biologic therapies (PRP stem cells) • corticosteroids • Activity modifications • physiotherapy
  11. 11. Surgical Treatment Options • Joint preserving surgery Synovectomy Arthroscopy • Shoulder replacement surgery • Hemiarthroplasty • Total shoulder replacement • Reverse shoulder replacement
  12. 12. Joint preserving surgery Arthroscopic Synovectomy • Early stages of inflammatory arthritis. • Removes inflamed tissue lining. • Potentially saves joint from further damage. • Not a permanent solution
  13. 13. Joint preserving operation Arthroscopy • Used when osteoarthritis causes small pieces of cartilage to wear away from joint and float around. • Removes any debris and smoothes cartilage surfaces. • Thylacotomy
  14. 14. Shoulder replacement when to consider; • Experience significant pain. • Reduced or loss of function despite non-surgical treatments. • Quality of life has significantly changed. • Medications for pain are no longer effective.
  15. 15. Arthroplasty Options-resurfacing
  16. 16. Arthroplasty Options-resurfacing
  17. 17. Pre op
  18. 18. 7 months post-op
  19. 19. 7 years post-op
  20. 20. Resurfacing arthroplasty • Initially reported very good results by Copeland and Levy • Younger patients • Good bone stock-preserved humeral head • Minimal surgery very attractive But • Technically demanding . Avoid overstuffing the joint . Wear of the glenoid
  21. 21. Hemiarthroplasty Total Shoulder Reverse Total Shoulder Arthroplasty Options
  22. 22. Arthroplasty Options Anatomic preserved-functioning rotator cuff
  23. 23. Arthroplasty Options stemless preserves bone stock –younger patients
  24. 24. Arthroplasty Options
  25. 25. Patient positioning / c-Arm Deltopectoral
  26. 26. Surgical Approach Deltopectoral Coracoid
  27. 27. Total shoulder replacement- anatomic functioning rot cuff Depending on the damage, the surgeon may replace: – Only the humeral head (hemiarthroplasty) – Both the humeral head and glenoid
  28. 28. Reverse shoulder arthroplasty • Designed for end-stage cuff tear arthropathy sufferers • Extreme shoulder degeneration; cannot function normally • May improve motion and stability by changing shoulder mechanics • Because the shoulder mechanics have been reversed, the stronger muscles can now lift the arm.
  29. 29. Reverse shoulder arthroplasty Recommended for patients: • Age 70 years or older • Experience significant pain • Have little to no movement in their shoulder Not Recommended for patients: • With bone disease, deficiencies in the scapula or non-functioning deltoid muscles • Younger or physically active
  30. 30. Grammont reverse TSA • The lever arm distance (L) is increased and deltoid force (F) is increased by lowering and medializing the center of rotation which is now also fixed • Torque (F x L) in abducting the arm is increased. Grammont Reverse Shoulder Arthroplasty - Biomechanics
  31. 31. Reverse TSA recruits more deltoid fibers Ant. Pos. Medializing the center of rotation recruits more of the deltoid fibers for elevation or abduction Grammont Reverse Shoulder Arthroplasty - Biomechanics
  32. 32. Reverse shoulder arthroplasty Potential Benefits to Patients from Surgery Return to mobility Restore their lifestyle Freedom
  33. 33. 7 months post op
  34. 34. Results after TSR • 5 year implant survival HA 89% TSR 95% Eichinger et al (2016)
  35. 35. Results after TSR • 5years 94.2 % • 10 years 90.2% • 20years 81.4 % Singh et al 2011 Mayo clinic
  36. 36. Results after TSR • Shoulder arthroplasty in patients younger than 50 years old minimum 20years FU 75pt TSR 83.2% HA 75.6 % Schoch et al (2015) Mayo clinic
  37. 37. Total shoulder replacement both shoulders 4 years post op
  38. 38. TSR both shoulders 2,5 months post op
  39. 39. Μάνος Αντωνογιαννάκης Διευθυντής Κέντρου Αρθροσκόπησης & Χειρουργικής Ώμου Διευθυντής Γ’ Ορθοπαιδικής Κλινικής Νοσοκομείου «ΥΓΕΙΑ» www.shoulder.gr Ευχαριστώ!

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