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Scientific Articles   |    
Technique for Reverse Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis with a Biconcave Glenoid
Mena Mesiha, MD1; Pascal Boileau, MD2; Gilles Walch, MD3
1 Massachusetts General Hospital, 55 Fruit Street, Yawkey 3G, Boston, MA 02114. E-mail address: mesiham@gmail.com
2 Hôpital de L’Archet, 2, 151, Route de Saint-Antoine de Ginestière, 06202 Nice, France. E-mail address: boileau.p@chu-nice.fr
3 Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France. E-mail address: walch.gilles@wanadoo.fr
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  • Disclosure statement for author(s): PDF

Based on an original article: J Bone Joint Surg Am. 2013 Jul 17;95(14):1297-304.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Nov 13;3(4):e21 1-6. doi: 10.2106/JBJS.ST.M.00048
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Extract

Overview
Introduction

Our technique to treat a biconcave glenoid (severe B2 subtype) with reverse total shoulder arthroplasty corrects the humeral head subluxation and associated posterior glenoid bone loss, both of which are difficult to address with a conventional anatomic arthroplasty procedure.

Step 1: Preoperative Planning

Obtain a preoperative computed tomography (CT) scan and make a detailed preoperative plan for reaming and bone-grafting.

Step 2: Surgical Approach

Perform a standard deltopectoral approach.

Step 3: Humeral Preparation

Prepare the humerus in a way that allows you to retain the humeral head for bone-grafting, being careful not to make an overly conservative first cut that effectively splits the intended bone graft.

Step 4: Glenoid Exposure

Proper glenoid exposure is an essential element of this operation and even more difficult for the B2 glenoid than in a standard total shoulder replacement.

Step 5: Glenoid Preparation

Having adequately visualized the glenoid, ream the anterior aspect of the glenoid in a way that executes your preoperative plan; do not ream >1 cm.

Step 6: Glenoid Fixation

Use the screws to compress the bone graft between the metaglene and the native glenoid.

Step 7: Closure

Proceed with your standard closure.

Results

We presented our results of this procedure in twenty-seven shoulders in twenty-seven patients with a mean duration of follow-up of fifty-four months (range, twenty-four to 139 months).

Indications

Contraindications

Pitfalls & Challenges

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    Video 1 The steps for planning the glenoid reconstruction.

    Running Time: 0:16

    Video 2 The early glenoid exposure including mobilization of the subscapularis and release of the glenohumeral ligaments.

    Running Time: 2:03

    Video 3 Excision of the perilabral structures to ensure adequate posterior glenoid exposure.

    Running Time: 1:12

    Video 4 Insertion of the guide pin for the reamer on the basis of the preoperative plan.

    Running Time: 0:13

    Video 5 Initial glenoid reaming.

    Running Time: 0:53

    Video 6 Evaluation of the extent of the reaming so as to not overly medialize. On this short video you see that the reaming is <50% of the glenoid face, which is evident in that the reaming edge line has not yet passed the guide pin placed in the center of the glenoid. This means that more reaming is needed.

    Running Time: 0:04

    Video 7 Final glenoid reaming.

    Running Time: 0:40

    Video 8 Drilling of the hole for the central post.

    Running Time: 0:20

    Video 9 Drilling of the peripheral holes.

    Running Time: 1:05

    Video 10 Placement of bone graft onto the metaglene component and fashioning it to conform to the prepared surface of the glenoid.

    Running Time: 3:20

    Video 11 Insertion of the metaglene-bone graft construct.

    Running Time: 2:08

    Video 12 Drilling of the inferior screw hole.

    Running Time: 0:20

    Video 13 Sequential tightening of the superior and inferior compressive screws.

    Running Time: 1:06

    Video 14 Placement of anterior and posterior locking screws.

    Running Time: 1:45

    Video 15 Insertion of the glenosphere.

    Running Time: 0:51

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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