Remplissage james wilson

1. “I have a simple 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 head defects
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 by Purchase 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

5. 7

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 29.5 months
• 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
Remplissage 94.6 (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 or subluxation
• Remplissage 6.3%
21/333
• Weber osteotomy 5.6%
• Allograft reconstruction 0%
• Arthroplasty 14%
Recurrence of instability

14. • Remplissage did not significantly affect ROM
• Studies comparing Bankart to Bankart plus remplissage - no
significant difference.
Range of motion

15. • Franceschi
• Comparative study
• 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 study designed 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

19. Follow up