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Arthroplasty after glenohumeral fusion a case report
J. Shoulder Elbow Surg. Volume 4, Number 1, Part 2
85
ARTHROPLASTY
AFTER G L E N O H U M E R A L FUSION A CASE R E P O R T
Abstracts
87
THE CONCEPT OF A SELECTIVE CAPSULAR SHIFT FOR TREATMENT OF ANTERIOR-INFERIOR INSTABILITY. J.J.P. Warner, M.D., D.L. Johnson, M.D., M.D. Miller, M.D., & D.N.M. Caborn, M.D., Dept. of Orthopaedic Surgery, Univ. of Pittsburgh, PA. This study presented a questionnaire to the members of the A.S.E.S. about how they perform an anterior-inferior capsular shift for the traumatic anterior-inferior instability. Additionally, the technique and preliminary results of a modified capsular shift procedure are presented. 80% of the A.S.ES. members agreed that arm position was important at the time of capsular repair though there was no consensus as to the best position. A "selective" capsular shift which fixes the inferior capsule with the shoulder abducted and externally rotationed and the superior capsule, with the shoulder adducted and externally rotated was performed on 18 patients. At a minimum 2 year follow-up 61% had full E.R. as measured with the shoulder in abduction in the coronal plane, 3 lost 5°, 3 lost 10°, and 1 lost 20 °. It is emphasized that if E.R. was measured with the arm abducted in the scapular plane, there was no apparent motion loss. CONCLUSION: Selective tensioning of the superior & inferior capsule in cases of anterior-inferior instability theoretically produces a physiologic repair with minimal motion loss. E.R. should be measured in abduction in the coronal plane in order to measure function motion for throwing.
88
TECHNIQUE OF CAPSULAR SHIFT RECONSTRUCTION OF THE S H O U L D E R Charles A. Rockwood, MD & Michael A. Wirth, MD, Univ. of TX Health Science Center, 7703 Floyd Curl Dr., San Antonio, Texas 78284-7774 USA Between 1980 and 1990, an anatomic capsular shift procedure was used to repair 182 shoulders with recurrent anterior shoulder instability. The study group consisted of 142 shoulders with recurrent anterior glenohumeral instability which were unresponsive to a specific shoulder rehabilitation program and had a minimum follow-up of two years. In 90 shoulders the anatomic capsular shift was the primary procedure, and in 52 shoulders the procedure was used to manage one or more failed previous reconstructions. Traumatic injuries (Group I) accounted for recurrent instability in 76 per cent of the shoulders, while atraumatic injuries (Group II) were present in the remaining 24 per cent. The capsular shift procedure was combined with repair of the anterior capsule back to the rim of the glenoid in 32 per cent of the traumatic injuries. According to the grading system of Rowe, et.al., 93 per cent of the results were rated as good or excellent at an average follow-up of 4.5 years (range, 2 to 11.5 years).
R. Hertel, M.D., F. Ballmer, M.D. Upper Extremity Unit Department of Orthopedic Surgery Inselspital, University of Berne, Switzerland We present a case of conversion of a glenohumeral fusion to an arthroplasty. The scarce literature on the subject justifies this report. Resistant, chronic pain in the scapulo-thoracic joint after shoulder arthrodesis, in the presence of a functional deltoid muscle, was judged to be an indication for conversion to a prosthesis. A deeply reamed glenoid fossa skeietally stabilizes the prosthetic head. A glenoid component was not used. Pain relief was dramatic and permanent. As expected, function was poor. Overall the patient was subjectively greatly improved. The Constant score improved from 2 to 25 points. This solution might be considered as a salvage procedure for the rare instances of resistant chronic pain originating in the scapulo-thoracic joint after glenohumeral fusion.
86
TECHNICAL DIFFICULTIES IN IMPLANTING TEP OF GLENOIIUMERAL JOINTS P.Balvanyossy,MD. Csepel Hospital, Budapest, Hungary. In our Institution there have 40 cases of TEP implantation been performed in the glenohumeral (GH) joint during the period of 1991 and 1993. In 4 cases following osteoarthritis, 3 times after rheumatoid arthritis, in 9 cases after acute, in 17 cases in non recent four part displaced fractures and in 9 cases following inveterate luxation of the GH joint. Due to a technical failure we had to perform only one early revision. In our practice in most cases BIOMET Bio-modular cementless prosthesises were implanted.The modular system is of major importance since the soft tissues are of different tension. To sustain the glenoid components in case of variing bone deficit of the glenoid, in 5 cases we implemented co~cal blocks from os ilei. We replaced the traumatic bone deficits of the tuberositae with cortical blocks, and sutured the rotating cuffto the reconstructed area. Following the operations we introduced early functional treatment. During the performance of the 40 implantation we never experienced any septical complications. In our early follow-up we experienced overhead function only in those cases when the rotating cuff was intact or properly reconstructed . Our experiences in implanting TEP in the GH joint suggest, that early results are based on the one hand on adequate knowledge and technique in soft tissue surgery and on the other optimal cooperation and functional activity of the patient.
$39
85
ARTHROPLASTY
AFTER G L E N O H U M E R A L FUSION A CASE R E P O R T
Abstracts
87
THE CONCEPT OF A SELECTIVE CAPSULAR SHIFT FOR TREATMENT OF ANTERIOR-INFERIOR INSTABILITY. J.J.P. Warner, M.D., D.L. Johnson, M.D., M.D. Miller, M.D., & D.N.M. Caborn, M.D., Dept. of Orthopaedic Surgery, Univ. of Pittsburgh, PA. This study presented a questionnaire to the members of the A.S.E.S. about how they perform an anterior-inferior capsular shift for the traumatic anterior-inferior instability. Additionally, the technique and preliminary results of a modified capsular shift procedure are presented. 80% of the A.S.ES. members agreed that arm position was important at the time of capsular repair though there was no consensus as to the best position. A "selective" capsular shift which fixes the inferior capsule with the shoulder abducted and externally rotationed and the superior capsule, with the shoulder adducted and externally rotated was performed on 18 patients. At a minimum 2 year follow-up 61% had full E.R. as measured with the shoulder in abduction in the coronal plane, 3 lost 5°, 3 lost 10°, and 1 lost 20 °. It is emphasized that if E.R. was measured with the arm abducted in the scapular plane, there was no apparent motion loss. CONCLUSION: Selective tensioning of the superior & inferior capsule in cases of anterior-inferior instability theoretically produces a physiologic repair with minimal motion loss. E.R. should be measured in abduction in the coronal plane in order to measure function motion for throwing.
88
TECHNIQUE OF CAPSULAR SHIFT RECONSTRUCTION OF THE S H O U L D E R Charles A. Rockwood, MD & Michael A. Wirth, MD, Univ. of TX Health Science Center, 7703 Floyd Curl Dr., San Antonio, Texas 78284-7774 USA Between 1980 and 1990, an anatomic capsular shift procedure was used to repair 182 shoulders with recurrent anterior shoulder instability. The study group consisted of 142 shoulders with recurrent anterior glenohumeral instability which were unresponsive to a specific shoulder rehabilitation program and had a minimum follow-up of two years. In 90 shoulders the anatomic capsular shift was the primary procedure, and in 52 shoulders the procedure was used to manage one or more failed previous reconstructions. Traumatic injuries (Group I) accounted for recurrent instability in 76 per cent of the shoulders, while atraumatic injuries (Group II) were present in the remaining 24 per cent. The capsular shift procedure was combined with repair of the anterior capsule back to the rim of the glenoid in 32 per cent of the traumatic injuries. According to the grading system of Rowe, et.al., 93 per cent of the results were rated as good or excellent at an average follow-up of 4.5 years (range, 2 to 11.5 years).
R. Hertel, M.D., F. Ballmer, M.D. Upper Extremity Unit Department of Orthopedic Surgery Inselspital, University of Berne, Switzerland We present a case of conversion of a glenohumeral fusion to an arthroplasty. The scarce literature on the subject justifies this report. Resistant, chronic pain in the scapulo-thoracic joint after shoulder arthrodesis, in the presence of a functional deltoid muscle, was judged to be an indication for conversion to a prosthesis. A deeply reamed glenoid fossa skeietally stabilizes the prosthetic head. A glenoid component was not used. Pain relief was dramatic and permanent. As expected, function was poor. Overall the patient was subjectively greatly improved. The Constant score improved from 2 to 25 points. This solution might be considered as a salvage procedure for the rare instances of resistant chronic pain originating in the scapulo-thoracic joint after glenohumeral fusion.
86
TECHNICAL DIFFICULTIES IN IMPLANTING TEP OF GLENOIIUMERAL JOINTS P.Balvanyossy,MD. Csepel Hospital, Budapest, Hungary. In our Institution there have 40 cases of TEP implantation been performed in the glenohumeral (GH) joint during the period of 1991 and 1993. In 4 cases following osteoarthritis, 3 times after rheumatoid arthritis, in 9 cases after acute, in 17 cases in non recent four part displaced fractures and in 9 cases following inveterate luxation of the GH joint. Due to a technical failure we had to perform only one early revision. In our practice in most cases BIOMET Bio-modular cementless prosthesises were implanted.The modular system is of major importance since the soft tissues are of different tension. To sustain the glenoid components in case of variing bone deficit of the glenoid, in 5 cases we implemented co~cal blocks from os ilei. We replaced the traumatic bone deficits of the tuberositae with cortical blocks, and sutured the rotating cuffto the reconstructed area. Following the operations we introduced early functional treatment. During the performance of the 40 implantation we never experienced any septical complications. In our early follow-up we experienced overhead function only in those cases when the rotating cuff was intact or properly reconstructed . Our experiences in implanting TEP in the GH joint suggest, that early results are based on the one hand on adequate knowledge and technique in soft tissue surgery and on the other optimal cooperation and functional activity of the patient.
$39