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Inlay humeral stem

6/26/2022

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The inlay stem offers specific advantages
1. bone conservation
2, easier revision
3. less calcar resorption
4. helpful in small patients
5. less tendency to stuff the joint


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Importing postoperative xrays

6/26/2022

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IMO, importing the post operative xray image into the software program  may be helpful.  assessment of lateralization, distalization, DSA and positioning of the implant 
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DistaLization IN REVERSE SHOULDER ARTHROPLASTY

6/26/2022

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a DSA between 40° and 65° results in better active anterior elevation  and abduction 
Case example:
​using an onlay system, the distalization is 26 mm and DSA angle is 71%
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using an inlay system, the DSA is reduced to 62 degrees and distatlization is 17 mm

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Maybe distalization greater than 20-25 mm may result in a difficult reduction. A lower neck cut, smaller sphere ,  or using an inlay stem are options. I think (opinion) the preop planning software to include DSA to anticipate tightness of shoulder reduction
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change in center of rotation with reverse total shoulder arthroplasty

6/24/2022

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The COR was medially displaced by 28 4 mm with the Delta prosthesis and by 19 3 mm with the Encore prosthesis 
​Matthew D. Saltzman, MDa , Deana M. Mercer, MDc , Winston J. Warme, MDb , Alexander L. Bertelsen, PA-Cb , Frederick A. Matsen III, MDb, * 
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​: Frederick A. Matsen III, MD, Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Box 356500, 1959 NE Pacific St, Seattle, WA 98195. E-mail address: matsen@u.washington.edu (F.A. Matsen III).
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Reverse tsr replacement for The tight Shoulder

6/23/2022

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Causes of a tight shoulder with a reverse shoulder arthroplasty:
SUPERIOR HUMERAL MIGRATION
MEDIALIZED HUMERUS
TIGHT CAPSULE 
HIGH NECK CUT
EXCESSIVE LATERALIZATION OF BASE PLATE
EXCESSIVE LATERALIZATION OF SPHERE
LARGE MUSCULAR MALE
LOW  GLENOSPHERE 
OVERSIZED GLENOSPHERE
ONLAY SYSTEM
INTACT ROTATOR CUFF
PRIOR SURGERY
PREOPERATIVE STIFFNESS
LARGE DELTOID
INCOMPLETE PARALYSIS
FAILED INTERSCALENE BLOCK 
​
Expect a tight reduction of the reverse shoulder if the preop planning software shows a distalization greater than 20 mm and DSA angle greater than 60 degrees in my opinion. This is not validated.
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HEIGHT OF THE HUMERAL STEM

6/22/2022

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Estimating posterior humeral subluxation

6/18/2022

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J Shoulder Elbow Surg
2012 Sep;21(9):1136-41.
Glenoid morphology rather than version predicts humeral subluxation: a different perspective on the glenoid in total shoulder arthroplastyHeinz R Hoenecke Jr 1, Lisa M Tibor, Darryl D D'Lima
Glenoid version did not correlate with humeral subluxation. The highest frequency of posterior subluxation was noted in biconcave glenoids.

​Bone & Joint OpenVol. 3, No. 6
Shoulder & ElbowIs there a correlation between humeral osteoarthritis and glenoid morphology according to Walch?Philipp Vetter
Petra Magosch
Peter Habermeyer
Increased humeral osteophyte length correlated with a higher grade of glenoid morphology (A1-A2-B1-B2-B3) according to Walch (r = 0.672; p < 0.0001).
​The criteria of humeral OL and HH morphology are associated with increasing glenoid retroversion, posterior humeral subluxation, and eccentric glenoid wear. Therefore, humeral radiological parameters might hint at the morphology on the glenoid side.


In a small sample size, I have found a corrrelation between posterior humeral subluxation and glenoid version
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Anatomic vs Reverse Arthroplasty

6/15/2022

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Small anatomy;
​degenerative tuberosity cysts;
glenoid version 13 degrees
80% posterior humeral subluxation
Lateralized offset humerus
Are these factors to consider?
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Humeral retroversion

6/13/2022

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Humeral retroversion is variable among individuals, and there are several measurement methods.
The mean humeral retroversion was 31.42° ± 12.10° using CT methods; the method using the bicipital groove center showed lower concordance, whereas the method using the posterior margin of the bicipital groove demonstrated higher concordance
Predicting humeral head retroversion preoperatively may be helpful although 10 degrees may not be significant
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    Share your insights and experience with total and reverse shoulder replacement surgery; please  reference   link to www.completeshoulder.com
    ​These comments are opinion only
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Serving The Villages,  Clermont , Haines City and  Davenport 
Heart of Florida Adventhealth, Orlando Health Southlake 


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M-F: 7am - 9pm

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352-243-6899

Email

focusorthopedics@hotmail.com
  • Home
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  • Rp measurement
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  • contact
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About us

Dr. Michael Messieh is a specialized shoulder surgeon specializing in reverse shoulder replacement surgery. Our mission is to provide patients with the best possible care and support throughout the surgical process.

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Email: focusorthopedics@hotmail.com
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