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Remplissage james wilson
The document discusses the surgical technique of remplissage, which involves filling in a bony defect (Hill-Sachs lesion) on the humeral head that commonly results from shoulder dislocations. Remplissage is performed after a Bankart repair by freshening the Hill-Sachs lesion and capsule before securing the tissue to restore stability. Studies have found that remplissage provides improved outcomes over other procedures with low complication and recurrence rates and no loss of range of motion. However, patient factors like the degree of glenoid bone loss must be considered when determining if remplissage is an appropriate additional procedure.
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Remplissage james wilson
- 1. “I have asimple philosophy: Fill what’s empty. Empty what’s full. Scratch where it itches.” Alice Roosevelt Longworth Remplissage James Wilson ST8 Trainee T&O Upper Limb Fellow Wrightington Hospital
- 2. • Remplissage - •filling • filling in • filling out • padding • charging Definition
- 3. • Humeral headdefects commonly associated with dislocation • Hill-Sachs lesion = impression fracture postero superior (>80%) • Large defect reduces rotational arc length • Engagement leads to recurrent dislocation Background Hill HA Sachs MD . The grooved defect of the humeral head. A frequently unrecognized complication of dislocations of the shoulder joint. Radiology. 1940;35:690-700.
- 4. • Published byPurchase et.al as a Technical Note in Arthroscopy • Posterior portal for initial assessment • Antero-Superior portal then used for viewing • Hill-Sachs and capsule freshened • Bankart repair prepared Description
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- 8. • September 2014- Systematic review in Arthroscopy • Looked at studies reporting outcomes for: • Remplissage • Weber osteotomy • Allograft reconstruction • Arthroplasty What is the evidence
- 9. • Remplissage 29.5months • Weber osteotomy 108 months • Allograft reconstruction 61.3 months • Arthroplasty 51.4 months Follow up
- 10. • Remplissage 0.9%2/212 • Weber osteotomy 29% 53/184 • Allograft reconstruction 74% 17/23 • Arthroplasty 19% 20/104 Complications
- 11. Outcomes Constant Rowe score for instability ASES Remplissage94.6 (3) 89.4 (9) 89.1 (5) Weber Osteotomy 79 (1) Allograft 76.2 (3) Arthroplasty 58.2 (4) 71.4 (1) 65.8 (2)
- 12. • Dislocation orsubluxation • Remplissage 6.3% 21/333 • Weber osteotomy 5.6% • Allograft reconstruction 0% • Arthroplasty 14% Recurrence of instability
- 14. • Remplissage didnot significantly affect ROM • Studies comparing Bankart to Bankart plus remplissage - no significant difference. Range of motion
- 15. • Franceschi • Comparativestudy • Historical controls • Different surgeons • However, groups well matched for age and pathology • Average D/R index 30% • Good scores, no recurrence and good ROM in the R&B group More detail
- 16. • Cohort studydesigned to compare ROM for the two groups • Dissimilar groups: • ISIS 5 or 6 vs ISIS < 5 • Outcomes similar • ROM no difference • One recurrence per group Nourissat et al
- 18. • Stephen Burkhart •If D/R index >15% (about 4mm) high rate of recurrent instability • Minimal glenoid bone loss (<25%) • Where arthroscopic stabilisation planned but increased stability wanted • Not for inverted pear glenoids • Do the Bankart first Other opinions
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