Name: reverse total shoulder arthroplasty
Uploaded: 2011-07-05T12:00:00
Description: Watch this Scientific Journal Video about Reverse Total Shoulder Arthroplasty at JoVE.com

Este procedimento foi realizado usando o aequalis invertida Shoulder Prótese Total por Tornier Inc. Consulte Tornier Inc. para mais informações: <a href="http://www.tornier-us.com/">http://www.tornier-us.com/</a> .

1. Introdução: A articulação glenoumeral é uma articulação complexa. Tem mínima restrições ósseas e depende de um complexo equilíbrio de tensões entre o apoio tecidos moles para a função normal. Esta relação essencial permite que o ombro para ter uma grande variedade de movimento funcional. Quando esse equilíbrio for desatrelada, diferentes graus de disfunção ocorrer. A perda da função do manguito rotador, como uma lágrima de grande porte, pode causar tradução superior...

<ol>
	<li>Boileau, P., Sinnerton, R. J., Choinard, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arthroplasty+of+the+Shoulder.">Arthroplasty of the Shoulder.</a> J Bone Joint Surgery Br. 88, 562-575 (2006).</li><li>Boileau, P., Watkinson, D., Hatzidakis, A. M., Hovorka, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neer+Award+2005:+The+Grammont+reverse+shoulder+prosthesis:results+in+cuff+tear+arthritis,+fracture+sequelae,+and+revision+arthroplasty.">Neer Award 2005: The Grammont reverse shoulder prosthesis:results in cuff tear arthritis, fracture sequelae, and revision arthroplasty.</a> J Shoulder Elbow Surg. 15, 527-540 (2006).</li><li>Boileau, P., Watkinson, D. J., Hatzidakis, A. M., Balg, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grammont+reverse+prosthesis:+design,+rationale,+and+biomechanics.">Grammont reverse prosthesis: design, rationale, and biomechanics.</a> J Shoulder Elbow Surg. 14, 147S-161S (2005).</li><li>Cuff, D., Pupello, D., Virani, N., Levy, J., Frankle, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+shoulder+arthroplasty+for+the+treatment+of+rotator+cuff+deficiency.">Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency.</a> J Bone Joint Surg Am. 90, 1244-1251 (2008).</li><li>Edwards, T. B., Boulahia, A., Kempf, J. F., Boileau, P., Nemoz, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+rotator+cuff+disease+on+the+results+of+shoulder+arthroplasty+for+primary+osteoarthritis:+results+of+a+multicenter+study.">The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study.</a> J Bone Joint Surg Am. 84, 2240-2248 (2002).</li><li>Frankle, M., Siegal, S., Pupelo, D., Saleem, A., Mighell, M., Vasey, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=There+reverse+shoulder+prosthesis+for+glenohumeral+arthritis+associated+with+severe+rotator+cuff+deficiency.+A+minimum+two-year+follow-up+study+of+sixty+patients.">There reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients.</a> J Bone Joint Surg Am. 87, 1697-1705 (2005).</li><li>Guery, J., Favard, L., Sirveaux, F., Oudet, D., Mole, D., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty.+Survivorship+analysis+of+eighty+replacements+followed+for+five+to+ten+years.">Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years.</a> J Bone Joint Surg Am. 88, 1742-1747 (2006).</li><li>Martin, T. G., Lanotti, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty+for+acute+fractures+and+failed+management+after+proximal+humerus+fractures.">Reverse total shoulder arthroplasty for acute fractures and failed management after proximal humerus fractures.</a> Orthop Clin North Am. 39, 451-457 (2008).</li><li>Wall, B., Nove-Josserand, L., O'Conner, D. P., Edwards, T. B., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty:+a+review+of+results+according+to+etiology.">Reverse total shoulder arthroplasty: a review of results according to etiology.</a> J Bone Joint Surg Am. 89, 1476-1485 (2007).</li><li>Werner, C. M., Steinmann, P. A., Gilbart, M., Gerber, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+painful+pseudoparesis+due+to+irreparable+rotator+cuff+dysfunction+with+the+delta+III+reverse-ball-and-socket+total+shoulder+prosthesis.">Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the delta III reverse-ball-and-socket total shoulder prosthesis.</a> J Bone Joint Surg Am. 87, 1476-1486 (2005).</li></ol>

O uso de RTSA para artropatia do manguito rotador fornece melhorias significativas na faixa dor, do movimento e escores funcionais resultados. Satisfação geral do paciente variou de 80-95% na literatura atual. Como todos os procedimentos, RTSA não é sem risco. Relatos iniciais de complicação foram tão elevadas como 60%. Como as técnicas têm melhorado os índices de complicações diminuíram.

<table border="1"><tbody><tr><td> Nome do reagente </td><td> Companhia </td><td> Número de catálogo </td><td> Comentários </td></tr><tr><td> Aequalis invertida Ombro </td><td> Tornier, Inc. </td><td> nenhum </td><td> Para mais informações visite <a href="http://www.tornier-us.com/">http://www.tornier-us.com/</a> </td></tr></tbody></table>

reverse total shoulder arthroplasty

Artroplastia total de ombro reverso foi inicialmente aprovado para uso em artropatia do manguito rotador e bem como pseudoparalisia crônica sem artrite em pacientes que não eram apropriados para as reconstruções de transferência de tendão. Tradicionais opções cirúrgicas para esses pacientes eram limitados e os resultados funcionais foram sub-ótima e, às vezes catastróficas. O uso de artroplastia do ombro inverso foi encontrado para efetivamente restaurar esses pacientes a função e aliviar os sintomas associados com a doença. O procedimento pode ser feito através de duas abordagens, a deltopeitoral ou súpero. Taxas de complicações associadas ao uso da prótese têm variado 8-60% com relatórios mais recentes tendências inferiores, como experiente é adquirida. Opções para salvar um ombro reverso falhou prótese são limitadas e muitas vezes têm deficiência associada significativa. Indicações para o uso da prótese continuam a ser avaliados, incluindo seu uso para artroplastia de revisão, fratura do úmero proximal e tumor. Seleção cuidadosa do paciente é essencial porque os riscos significativos associados com o procedimento.

Watch this Scientific Journal Video about Reverse Total Shoulder Arthroplasty at JoVE.com

Reverse Total Shoulder Arthroplasty

Artroplastia ombro reverso total é indicado para o tratamento de condições que não podem ser tratados com artroplastia convencional ou outros procedimentos. Estes incluem, principalmente, condições degenerativas e incapacitantes, com irreparáveis ​​do manguito rotador e perda do acoplamento normais biomecânica do ombro.

Reversa Artroplastia Total do Ombro

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in ...

Research

JoVE Journal

Medicine

Implantation of the Syncardia Total Artificial Heart

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of such patients are generally well served by left ventricular assist devices (LVADs). However, a subset of patients with late stage biventricular failure or other significant anatomic lesions are not adequately treated by isolated left ventricular mechanical support. Examples of concomitant cardiac pathology that may be better treated by resection and TAH replacement includes: post infarction ventricular septal defect,&#160;aortic root aneurysm / dissection, cardiac allograft failure, massive ventricular thrombus, refractory malignant arrhythmias (independent of filling pressures), hypertrophic / restrictive cardiomyopathy, and complex congenital heart disease. Patients often present with cardiogenic shock and multi system organ dysfunction. Excision of both ventricles and orthotopic replacement with a total artificial heart (TAH) is an effective, albeit extreme, therapy for rapid restoration of blood flow and resuscitation. Perioperative management is focused on end organ resuscitation and physical rehabilitation. In addition to the usual concerns of infection, bleeding, and thromboembolism common to all mechanically supported patients, TAH patients face unique risks with regard to renal failure and anemia. Supplementation of the abrupt decrease in brain natriuretic peptide following ventriculectomy appears to have protective renal effects. Anemia following TAH implantation can be profound and persistent. Nonetheless, the anemia is generally well tolerated and transfusion are limited to avoid HLA sensitization. Until recently, TAH patients were confined as inpatients tethered to a 500 lb pneumatic console driver. Recent introduction of a backpack sized portable driver (currently under clinical trial) has enabled patients to be discharged home and even return to work. Despite the profound presentation of these sick patients, there is a 79-87% success in bridge to transplantation.

The purpose of this manuscript is to briefly review indications, management, and outcomes for the total artificial heart. Video operative techniques for device implantation are presented.

Implantação do Coração Artificial Total SynCardia

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of ...

Medicina

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life.
The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI.
We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.

Differential diagnostics in painful arthroplasty is crucial for treatment success. Joint aspiration is routinely performed preoperatively. Multiplex polymerase chain reaction of the joint aspirate and the sonication fluid, a feasible tool for quick pathogen detection from these samples is described.

Diagnóstico de romance em artroplastia de revisão: implante Sonication e reação em cadeia da polimerase Multiplex

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of ...

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short stems, differing in design and function. Calcar-guided short stems provide an anatomical curvature in the medial calcar region, thus, positioning is done individually alongside the calcar in the "round-the-corner" technique. Depending on the level of the neck's osteotomy, stems can be aligned individually in a large bandwidth of varus- and valgus anatomies. This differs from conventional total hip arthroplasty and potentially includes a severe learning curve. Given that a great variety of caput-collum-diaphyseal (CCD)-angles can be retained, the reconstruction of femoro-acetabular offsets can be achieved precisely. However, particularly extensive varus- and valgus positioning has raised concerns in regard to stability and bone remodeling. The purpose of the present manuscript is to showcase the implantation technique in calcar-guided short-stem THA and to summarize short-term clinical and radiological results.

This protocol describes the round-the-corner technique and the individualized stem-positioning of calcar-guided short stems alongside the medial calcar, depending on the level of the osteotomy. This differs from conventional total hip arthroplasty and includes a learning curve.

Haste-posicionamento individualizado em Calcar-guiados Short-tronco Artroplastia Total de quadril

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short ...

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, mice undergo RR upon removal of the aortic constriction. In this paper, we describe a step-by-step procedure to perform a minimally invasive surgical aortic debanding in mice. Echocardiography was subsequently used to assess the degree of cardiac hypertrophy and dysfunction during LV remodeling and RR and to determine the best timing for aortic debanding. At the end of the protocol, terminal hemodynamic evaluation of the cardiac function was conducted, and samples were collected for histological studies. We showed that debanding is associated with surgical survival rates of 70-80%. Moreover, two weeks after debanding, the significant reduction of ventricular afterload triggers the regression of ventricular hypertrophy (~20%) and fibrosis (~26%), recovery of diastolic dysfunction as assessed by the normalization of left ventricular filling and end-diastolic pressures (E/e&#39;&#160;and LVEDP). Aortic debanding is a useful experimental model to study LV RR in rodents. The extent of myocardial recovery is variable between subjects, therefore, mimicking the diversity of RR that occurs in the clinical context, such as aortic valve replacement. We conclude that the aortic banding/debanding model represents a valuable tool to unravel novel insights into the mechanisms of RR, namely the regression of cardiac hypertrophy and the recovery of diastolic dysfunction.

Here we describe a step-by-step protocol of surgical aorta debanding in the well-established mice model of aortic-constriction. This procedure not only allows studying the mechanisms underlying the left ventricular reverse remodeling and regression of hypertrophy but also to test novel therapeutic options that might accelerate myocardial recovery.

Estudando remodelagem reversa ventricular esquerda por debandagem aórtica em roedores

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, ...

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed reality were used to perform complex revision hip arthroplasty in January 2019. The use of mixed reality allowed for a very good visualization of the structures and resulted in precise implant fixation. According to the authors' knowledge, this is the first described case report of the combined use of these two innovations. The diagnosis preceding the qualification for the procedure was the loosening of the left hip's acetabular component. Mixed reality headset and holograms prepared by engineers were used during the surgery. The operation was successful, and it was followed by early verticalization and patient rehabilitation. The team sees opportunities for technology development in joint arthroplasty, trauma, and orthopedic oncology.

A complex revision hip arthroplasty was performed using a custom-made implant and mixed reality technology. According to the authors&#39; knowledge, this is the first report of such procedure described in the literature.

O Uso da Realidade Mista na Artroplastia de Quadril de Revisão Personalizada: Um Primeiro Relato de Caso

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed ...

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis (AMOA). The key to UKA is the flexion-extension gap balance, which is closely related to postoperative complications such as bearing dislocation, bearing wear, and arthritis progression. The traditional gap balance assessment is performed by indirectly sensing the tension of the medial collateral ligament by a gap gauge. It relies on the surgeon's feel and experience, which is imprecise and difficult for beginners. To accurately assess the flexion-extension gap balance of UKA, we developed a wireless sensor combination consisting of a metal base, a pressure sensor, and a cushion block. After osteotomy, the insertion of a wireless sensor combination allows the real-time measurement of intra-articular pressure. It accurately quantifies the flexion-extension gap balance parameters to guide further femur grinding and tibia osteotomy, to improve the accuracy of gap balance. We conducted an in vitro experiment with the wireless sensor combination. the results showed that there was a difference of 11.3 N after applying the traditional method of flexion-extension gap balance performed by an experienced expert.

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

This protocol presents a cadaveric study of a wireless sensor used in medial unicompartmental knee arthroplasty. The protocol includes the installation of an angle measuring device, standardized Oxford unicompartmental knee arthroplasty osteotomy, preliminary assessment of flexion-extension balance, and application of the sensor to measure flexion-extension gap pressure.

In vitro Aplicação de um sensor sem fio no equilíbrio do gap de flexo-extensão na artroplastia unicompartimental do joelho

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis (AMOA). The key to UKA is the ...

Terapia Tuina para ombros congelados em um modelo de rato

Tuina in a Frozen Shoulder Rat Model: An Efficient and Reproducible Protocol

Frozen shoulder (FS) is a common condition with no defined optimal therapy. Tuina therapy, a traditional Chinese medicine (TCM) technique used to treat FS patients in Chinese hospitals, has demonstrated excellent results, but its mechanisms are not fully understood. Building on a previous study, this work aimed to develop a Tuina protocol for an FS rat model. We randomly divided 20 SD rats into control (C; n = 5), FS model (M; n = 5), FS model Tuina treatment (MT; n = 5), and FS model oral treatment (MO; n = 5) groups. This study used the cast immobilization method to establish the FS rat model. The effect of Tuina and oral dexamethasone on the glenohumeral range of motion (ROM) was evaluated, and the histological findings were assessed. Our study showed that Tuina and oral dexamethasone were able to improve shoulder active ROM and preserve the structure of the capsule, with Tuina therapy proving to be more effective than oral dexamethasone. In conclusion, the Tuina protocol established in this study was highly effective for FS.

Autor em destaque: investigando a eficácia da terapia Tuina para ombro congelado 

This study develops an efficient and reproducible Tuina protocol for treating frozen shoulder established in a rat model. This approach will help to study the Tuina therapy treatment method for frozen shoulders.

Tuina em um modelo de rato de ombro congelado: um protocolo eficiente e reprodutível

Frozen shoulder (FS) is a common condition with no defined optimal therapy. Tuina therapy, a traditional Chinese medicine (TCM) technique used to treat FS ...

Eficácia terapêutica da terapia com faca de agulha pequena no tratamento de ombro congelado

Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder

Frozen shoulder is a kind of aseptic inflammatory disease of the shoulder caused by strain, trauma, and other reasons, resulting in shoulder joint pain and limited function. The protocol presented here demonstrates the operation of a small needle knife in treating frozen shoulders, including patient management, material preparation, positioning, operation, and postoperative care. The purpose of this protocol is to relieve the pain and functional limitations and improve the living ability of patients with frozen shoulders. In our study, 76 stage I-II frozen shoulder patients who met the inclusion criteria were randomly divided into a control group and a treatment group (n=38). Patients in the control group received functional exercise, while the treatment group received small needle knife therapy with functional exercise. The visual analogue scores (VAS), the Constant and Murley scores (CMS), and the thickness of the coracohumeral ligament (CHL) under ultrasound were evaluated. After small needle knife therapy, the VAS score was significantly lower in the treatment group (5.11 &plusmn; 0.89) than in the control group (5.49 &plusmn; 0.65; t=-2.065, p&lt;0.05); the CMS score was significantly higher in the treatment group (64.72 &plusmn; 4.78) than in the control group (60.97 &plusmn; 6.00; t=2.947, p&lt;0.05); the CHL thickness was significantly decreased in the treatment group (2.38 &plusmn; 0.36) than in the control group (2.57 &plusmn; 0.42; t=-2.117, p&lt;0.05). These results indicate that the small needle knife significantly relieved the pain symptoms, improved the shoulder function, reduced the CHL thickness, and improved the quality of life and, therefore, had significant therapeutic efficacy in stage I-II frozen shoulder patients.

Autor em destaque: Tratando o ombro congelado com terapia com faca de agulha pequena 

The protocol presented here describes the detailed operation method and proves the effectiveness of a small needle knife in the treatment of frozen shoulders.

Eficácia clínica da terapia com faca de agulha pequena no ombro congelado estágio I-II

Frozen shoulder is a kind of aseptic inflammatory disease of the shoulder caused by strain, trauma, and other reasons, resulting in shoulder joint pain ...