STEMLESS SHOULDER ARTHROPLASTY - COA

1 STEMLESS SHOULDERARTHROPLASTYJOHN G. COSTOUROS, MD FACSS tanford UniversityDepartment of Orthopaedic Surgery Disclosures Royalties: Arthrex, SHOULDER Options, Inc., Tornier Consultant: Arthrex, Zimmer, Tornier, Depuy-Synthes, Depuy-Mitek, SHOULDER Options, John Charnley(1911-1982)Charles S. Neer, II (1917-2011)Evolution of the SHOULDER Prosthesis: 1stGenerationNeer I (1951): Monoblock Single headsize Fixed geometry inclinationangle version offset Press-fit systemEvolution of the SHOULDER Prosthesis:1stGenerationNeer II (1973): Monoblock 2 headsizes(15mm/22mm) 25mm radiusofcurvature Cementfixation Glenoidcomponentlate70 s2ndGeneration (1988) Modular Separate headandstemEvolution of the SHOULDER Prosthesis:2ndGeneration Fixed geometry inclinationangle version offset3rdGeneration (1992) Separate headandstem 3 dimensional modularity Variable geometry inclination version offset Newersystemsallowforin situ adjustmentEvolution of the SHOULDER ProsthesisStemlessShoulder Arthroplasty4th Generation (2013).

2 Bonepreserving Allowsglenoid access 4 FDA IDE sin US Not humeralresurfacing!EclipseSidusTESSS implicitiNOTH umeral Resurfacing!!Humeral ResurfacingLee et al., Biomechanical comparison of humeral head resurfacing and hemiarthroplasty , JBJS 94:68, 2012 Indications: Younger patients with focal cartilage defects Minimal glenoidarthrosis Advantages: Bone stock preservation Maintains biomechanics of joint and limits eccentric glenoidwearOutcomes of Humeral Resurfacing Prospective study of 102 shoulders (Copeland). OA (47%), RA (40%), RCTA (9%), AVN (4%) Mean age 66yrs, (M/F: 60/40%) Highest patient satisfaction #1: AVN #2-4: OA, RA, RTCA *In RTCA, high rates of glenoid erosion and humeral head proximal migration over timeAlizadehkhaiyatet al.

3 , JSES 22:1352, 2013. Minimum 4yr followup:Outcomes of Humeral ResurfacingMinimum 20yr followup: Prospective study of 74 shoulders in 61 pts. Mean age 58yrs 41 Total-resurfacing 33 Hemi-resurfacing Patient satisfaction 95% Survivorship 96% 2 revised to stemmed humeral componentPritchett JW, JSES 20:771, 2011 Partial Resurfacing Retrospective study of 39 shoulders (Arthrosurface) Min 2yr f/u, mean 51 months Mean age: 46 years (27-76) 64% improved pain and function (ASES 29 70)* 25% failure rate requiring revision Risk factors: prior surgery, concomitant proceduresDelaney et al., JSES 23(12):1, 2013 StemlessShoulder ARTHROPLASTY >10,000 implantedworldwidesince2004 2 typesofmetaphysealanchorage Fin system Cage screwsystem Fin systempreferablein osteopaenicboneAmbacherT.

4 , Orthop de42(7):495, Rationale Primary stability by shifting fixation of trunionclose to the center of rotation Center of rotation of head independent of axis of shaft Ideal for deformity cases Malunions Anatomic Bone preserving Ease of revision Avoid broaching/reaming humeral shaftEclipse FDA IDE clinical trial at Stanford Habermeyer(Germany) Cementless Hollow screw fixation Fenestrations for bone ingrowth Blasted trunionwith fins for rotational stabilityHumeral Components Headsizes 39-53mm Cage screw 4 Cage screw sizes Trunion rough blasted surface with anti-rotational fins CementlessGlenoid Components All Poly Cemented Glenoids: UHMWPE Keeled & Pegged Indications and technique for glenoid implantation same as traditional TSAA dvantages to the Traditional Stemmed Prostheses Varus positioning of stem -overstuffs joint Stem height too high limits ROM and leads to rotator cuff tears Version -affects rotational ROM and stability Stress riser distally: humeral shaft fracturesEuropean Experience: Austria Prospective study 63 shoulders in 60 patients from 2005-2007 Constant score increased from 25 to 56 at 1 year and to 62 at 2 years ROM: Flexion 90-130 , ER 20-40 No mechanical complicationsPresented ESSKA 2010 Two-year results of the stemlesseclipse prosthesis -a prospective studyHeubererP.

5 , KrieglederB., Laky B., Vincent Hospital, Department of Orthopedics, Vienna, AustriaCanadian Experience: Vancouver 135 prospective cases compared with matched cohort of standard TSA at 1 yraverage f/u Mean age years (48-80) M/F ratio ( :1) ASES improvement 41pts at 12 mosf/u in stemlesscases No sig difference between groups (WOOS, ASES) Operative time sig less in stemlessgroup 75min versus 97minCanadian Experience: Ontario Prospective study 74 patients comparing 3 TSA designs 2 yrmin followup Improved clinical outcomes in all groups (p< ) Worst clinical and radiographic outcomes NeerII No relationship between implant and pt. satisfactionTESSBFNeerIIRazmjouet al., JSES 22:206, 2013 France and Belgium Experience 72 prospective shoulders in 70 patients receiving TESS prosthesis Minimum 3 year followup(mean 45 mos) Constant score improvement 29 75 (p< ) No radiolucenciesor implant migrationHuguetet al.

6 , JSES 19:847, 2010 Surgical technique: Eclipse My First Eclipse! 65yo male with Primary OASurgical technique: Eclipse Anatomical neck identified and cut Cutting guide not necessary Proceed to glenoid implantationTrunion& Cage Screw PreparationTrunion& Cage Screw PreparationTrunionInsertionCage Screw InsertionHead insertionPostop Radiographs65yo with arthritis, chronic pain, and poor function73yo with Post-Traumatic ArthritisHumeral MalunionHumeral MalunionResults of the Stanford IDE Traditional TSA provides consistent pain relief and functional improvement StemlessTSA is currently under investigation in the USA with encouraging early results worldwide Enables anatomic SHOULDER reconstruction independent of the stem axis with simple component geometry and instrumentation Preserves bone stock and facilitates revisionsThank You!