Name:
Resurfacing Hemiarthroplasty To Treat Glenohumeral Joint (Shoulder) Osteoarthritis
Description:
Resurfacing Hemiarthroplasty To Treat Glenohumeral Joint (Shoulder) Osteoarthritis
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/7d644aa3-0ed7-480a-b150-49ba22ec59ef/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H08M29S
Embed URL:
https://stream.cadmore.media/player/7d644aa3-0ed7-480a-b150-49ba22ec59ef
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/7d644aa3-0ed7-480a-b150-49ba22ec59ef/Resurfacing hemiarthroplasty to treat glenohumeral joint (sh.mp4?sv=2019-02-02&sr=c&sig=7BqhMYEyQy0LsmWmW09NrwYLneG6cRefb1VIc%2BTsP8U%3D&st=2024-11-23T09%3A22%3A21Z&se=2024-11-23T11%3A27%3A21Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
ALEJANDRO BADIA: Technique of shoulder resurfacing, hemi arthroplasty will be reviewed. This is done on patients who have glenohumeral joint space narrowing as seen here and in this case a large inferior osteophyte. This is a heavyset, middle aged female who developed shoulder pain after a work injury and was found to have underlying osteoarthritis.
ALEJANDRO BADIA: This will be a deltopectoral approach initially with scalpel followed by bovie cauterizer. We will identify the interval between the deltoid and the pec major looking for fat that is typically surrounding the cephalic vein as seen here. We develop that interval, taking the vein in this case medially, although that will be the surgeon's choice. Self retainer will be used to then retract the deltoid laterally.
ALEJANDRO BADIA: We are now developing that interval digitally, and then the medial arm will retract the conjoined tendon towards the medial side, also taking the cephalic vein with it. We take the weitlaner out and now identify the clavi pectoral fascia, which is divided, allowing us to expose the subscapularis. Hohmann retractors placed underneath the CA ligament
ALEJANDRO BADIA: and then incision is made in the sub-scap, leaving a good, healthy cuff of tissue on the lateral side for later suturing. Some surgeons prefer to do this with a small fleck of bone for bony healing. Two ethibond sutures are used to tag the subscapularis, which will be critical throughout the procedure. Clamps are placed to control it, and we will then further begin elevating the capsule away from the underlying humeral head, which soon comes into view.
ALEJANDRO BADIA: Typically, fluid will emanate from the arthritic joint at this point and will then begin elevating the capsule off the neck of the humerus. Therefore a second Hohmann is placed underneath the humeral head, allowing us to release the inferior capsule and begin externally rotating the arm as seen here. At this point, full external rotation of the arm is done, allowing a skid to help us dislocate the shoulder and then a bi-pronged retractor is placed inferiorly.
ALEJANDRO BADIA: The inferior osteophytes are better identified here and removed with an osteotomy followed by a rongeur. This is important in order to better define the actual humeral head. Smaller osteophytes will later be removed. We can see the humeral head is devoid of cartilage and this sizing guide is used to place the center pin through the guide here.
ALEJANDRO BADIA: So we noted that the 42 was a bit small so we went back to a 46 millimeter head. It's important that this is placed in the center since all reaming and drilling will be done around this guidewire.
ALEJANDRO BADIA: We confirm that it's in the center and then this sizing guide is confirmed followed by the reamer, which will remove any remaining articular cartilage as well as some subchondral bone to get a bleeding surface, which will help for the implant to adhere itself through bony ingrowth. As seen here, now that the reaming was done, there is a small margin of bone and osteophytes that are removed with a ronguer.
ALEJANDRO BADIA: During this period we're also further releasing the capsule. This guide also will have a self stopping component so that we don't drill too deep with our center post reaming. So now we have the correct depth and we'll be able to place our trial that is melded into place
ALEJANDRO BADIA: and this gives us a good idea of the sizing and allows us to now perform a transient reduction in order to confirm if sizing is adequate. To do this, we first irrigate out the joint any additional bony fragments that have removed retractors. And we'll pull on the sutures that have the subscapularis while we now reduce the joint by internally rotating.
ALEJANDRO BADIA: In this particular case, we, because the patient is obese, we did do a trial fluoroscopy showing that the trial is in good position. The shoulders easily dislocated once again and the trial is removed with this post and a mallet. Further osteophytes are removed as seen here
ALEJANDRO BADIA: and we confirm that we have a good free area in order to implant the definitive hemi implant, which has a plasma coat of titanium on its under surface for bony ingrowth to be impacted with a mallet and we'll confirm also that the implant is not sitting proud superiorly so there is no impingement on the rotator cuff. Preoperatively, MRI showed the rotator cuff was actually of good condition, which is critical for being an indication for this prosthesis.
ALEJANDRO BADIA: Reduction here shows excellent height of the head and as we see, the subscapularis can be easily repaired with a healthy cuff of tissue that was remaining and we will incorporate the long head of a bicep as essentially a soft tissue tenodesis. The intraarticular portion of the bicep tendon had been cut at the beginning of the surgical approach.
ALEJANDRO BADIA: These are Ethibond horizontal mattress stitches. Multiple ones are used in order to minimize the chance of subscapularis detachment. As the subscap is closed, we can remove the state sutures, which were used for retraction. Now we will do a trial range of motion, avoiding too much external rotation, but good forward flexion and confirming by a shuck test that there is no significant anterior translation.
ALEJANDRO BADIA: With accelerated video here, you'll see simply the deltoid closure. That's the interval closure followed by subcutaneous closure with 3-0 vicryl and skin staples will be used. This patient will begin therapy within 48 to 72 hours, therefore, good skin closure is critical in order to avoid any wound healing issues and a dressing is applied with paper tape
ALEJANDRO BADIA: and on the sling, you see the patient's head is protected here throughout. This was done with inter scalene block and LMA anesthesia. Post-op x-rays show excellent position of resurfacing implant. This is a technique that can be done on an outpatient basis with excellent results and good safety profile.
ALEJANDRO BADIA: Thank you. [VIDEO ENDS]
