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- 1. Total Shoulder Replacement Amal Alam David Babayev Rakshya Bista Shreenath Varma Wahaj Patel S
- 2. Glenohumeral joint Articular cartilage: prevents bone-on-bone friction. Labrum: offers the joint more stability Rotator cuffs: group of muscles, stabilize the joint http://www.eorthopod.com/sites/default/files/images/shoulder_anatomy_ligaments01.jpg 1. American Academy of Orthopedic Surgeons, http://orthoinfo.aaos.org/topic.cfm?topic=A00094, reviewed December 2011 2. Huguet D, DeClercq G, Rio B, Teissier J. (2010) Results of a new stemless shoulder prosthesis: Radiologic proof of maintained fixation and stability after a minimum of three years' follow-up. Journal of Shoulder and Elbow Surgery, 19:847-852.
- 3. Normal Range of Motion http://www.crossfitskopje.com/wp-content/uploads/2012/12/bigliani_flatlow_shoulder3.jpeg S Forward flexion is the movement of the shoulder forward. Normal range of motion is 180 degree S pushing a door S lifting an object from the ground.
- 4. Normal Range of Motion S External Rotation: elbow bent to 90 degrees S Opening the front door S Normal range of Motion is 70 to 90 degrees http://t0.gstatic.com/images?q=tbn:ANd9GcRWzNgo0gKHQhaPWS9-boRsjQ0-Zguy7zQIR-PwY-iGx3ItGGct
- 5. Instability: ball ofthe humerus becomes larger than the shoulder socket that holds it. The muscles, tendons and ligaments, must anchor the shoulder in order to maintain the normal stability. The main causes for a total shoulder replacement revolve around arthritis. 1. American Academy of Orthopedic Surgeons, http://orthoinfo.aaos.org/topic.cfm?topic=A00094, reviewed December 2011 2. Hospital For Special Surgery, www.hss.edu, assessed October 2012
- 6. S Osteoarthritis: âwear and tearâ arthritis, most people are familiar with it, where the cartilage in the joint wears away over time. http://www.eorthopod.com/images/ContentImages/shou lder/shoulder_reverse_replacement/shoulder_reverse_ oa_rationale01.jpg 1. American Academy of Orthopedic Surgeons, http://orthoinfo.aaos.org/topic.cfm?topic=A00094, reviewed December 2011
- 7. Rheumatoid arthritis S an inflammation and thickening of the tissues around the joint http://www.fulllifeusa.com/images/fulllife_enfermedades_01.jpg 1. Hospital For Special Surgery, www.hss.edu, assessed October 2012
- 8. S Post-traumatic arthritis: follow a serious shoulder injury and cause fractures. S Fractures: common reason people have shoulder replacements, bones of the shoulder matter completely shatter, difficult to put the pieces back together. S Avascular necrosis, where the blood supply is severely hampered, causing bone death. http://www.eorthopod.com/images/ContentImages/Fractures/adult_fractures 1. American Academy of Orthopedic Surgeons, http://orthoinfo.aaos.org/topic.cfm?topic=A00094, reviewed December 2011 2. Hospital For Special Surgery, www.hss.edu, assessed October 2012
- 9. Total Shoulder Replacement S Glenoid is replaced with a plastic socket S Humeral head is metal S Metal portion is inserted into humeral bone www.lima.it
- 10. Procedure Part I S Glenoid is removed and cleaned S Three to four holes are drilled for the pegs of the implant S Cement or porous material is used for implantation http://www.zimmer.com
- 11. Procedure Part II S Humerus is sliced off and cleaned S The soft bone inside the humerus is drilled out S Cement might be injected into the humerus S Metal humeral stem is inserted and then the ball of the humerus is screwed and cemented to the top http://www.zimmer.com
- 12. Current Devices S Uses various porous material to allow bone ingrowth S Promotes natural fixation of implants S The glenoid can become loose regardless http://www.biomet.com http://www.zimmer.com
- 13. Reverse Shoulder Replacement S The glenoid and humeral pieces are switched S Uses different muscles to function S Generally for people with irreparable rotator cuff injuries, not used very often http://shoulderreplacement-hobgood.org
- 14. Experimental Set Up SIn Vivo human clinical trial S Anterior Active Elevation and Exterior Active Rotation will be measured in subjects at intervals of six months every two years S IRB Approved Clinical Trial
- 15. Working Hypothesis S Thenew device should increase both the external active rotation and anterior active elevation
- 16. Control Group S Wewill receive control group data from Biomet via collaboration on their Comprehensive ÂŽ Total Shoulder Replacement Model, which was tailored to patients with osteoarthritis.
- 17. Experimental Group People with Osteoarthritis People of all ages 18+ Patient Screening Reference: S http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/rich_media_quiz/topic/rmq_coping_with_acne/getty_rf_photo_of_diver se_group_of_people_of_all_ages.jpg
- 18. Power Analysis IMAGE andreference of tool used to calculate power analysis
- 19. Power Analysis Dependent Variable1: Anterior Active Elevation Expected average value: ___ degrees Test value of CTSS: ___ degrees (reference: Biomet client profile) Allowed Standard Deviation: 10 degrees (reference: TESS) Îą level: 5% Ď level: 10% Calculated Sample Size: ___
- 20. Power Analysis Dependent Variable2: External Active Rotation Expected average value: ___ degrees Test value of CTSS: ___ degrees (reference: Biomet client profile) Allowed Standard Deviation: 10 degrees (reference: TESS) Îą level: 5% Ď level: 10% Calculated Sample Size: ___ How many sample will we use: _____
- 21. Minimizing Sample Loss SSubstantial Discount for device S Sample size needed for dependent variable 2 is much smaller okay for some subject to leave mid-study Reference: http://modernpivotdoors.com/pivot-doors/security-door- locks/defendius-security-door-lock.jpg
- 22. Statistical Analysis S mediacrushllc.com
- 23. Normal Distribution S PercentileChecks S Normality Plot S Chi-squared goodness of fit Mathworks.com
- 24. Parametric Tests S MultivariateAnalysis of Variance S Two dependent variables S Anterior Active Elevation S External Active Rotation S Alternatively, we can conduct two repeated measures ANOVA S One for each dependent variable.
- 25. Nonparametric Test S FriedmanStatistic Guardian.co.uk
- 26.