2. f. einarsson axelprotes pv 2018

Axelproteskirurgi 27:e feb 2018

[email protected]

Alingsås

Pean 1893

Neer hemiprotes

Plattform

Surgical Technique GLOBAL® UNITE® Anatomic DePuy Synthes Joint Reconstruction 19

INSTRUMENT ORDERING INFORMATION

COMMON CASE

INSTRUMENT ORDERING INFORMATION

COMMON CASE

Bottom Tray – Trial Heads

2130-20-000 3.2mm Osteotomy Guide Pin – Long

2100-70-155 4.0mm Female Hex Screwdriver

2100-70-150 3.5mm Hex Screwdriver

2001-65-000 Humeral Head Impactor

2100-01-022 Impaction Stand

2100-11-400 Common Humeral Head 40 X 12 Trial















2100-22-401 Common Humeral Head 40 X 15 Eccentric Trial













Modularitet

IndikationerAxelprotes 2018

ssas.se (axelregistret)

Artros 40%

Fraktur 30%

Kuff 20%

Revision 10%

1 800 / år i Sverige 2015

Fler operationer fördelaktigt

> 26 / år / sjukhus

> 17,5 / år / kirurg

Preop rtg

Preop CT för glenoiden

Protesmall

Deltopectoralt snitt i strandstolsläge

Subscapularistenotomi

Ingen skillnad

Osteotomi av tub minus

Tenotomi av subscapularis

vid anatomisk protes

Ingen skillnad i funktion

Sutur av subscapularis

Ej sutur av subscapularis

vid omvänd protes

Delto-pectoralt snitt

Stabil benbädd

Kompakta benhål

Plastyta på glenoiden

GLENOSFÄR

Stam och huvud

HUMERUSSTAMOCH CUP

Bestående

förbättring över

tid

Både RSA o TSA ger stor förbättring avs

smärta och funktion

Det mesta av förbättringen inom 6 mån (2 år)

RSA sämre inåtrotation än TSA

RSA förbättrar inte utåtrotation

Shoulder arthroplasty in patients aged fifty-five years or

younger with osteoarthrit is

Robert Bartelt , MD, John W. Sperling, MD, Cathy D. Schleck, BS,Robert H. Cofield, MD*

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

Background: The younger patient with glenohumeral arthritis presents a challenge because of concerns

about activity and frequency of failure. The purpose of this study was to define the results, complications,

and frequency of revision surgery in this group.

Materials and methods: Between 1986 and 2005, 46 total shoulder arthroplasties and 20 hemiarthroplas-

tieswere performed in 63 patients who were aged 55 years or younger and had chronic shoulder pain due to

glenohumeral osteoarthritis. All 63 patients had complete preoperative evaluation, operative records, and

minimum 2-year follow-up (mean, 7.0 years) or follow-up until revision.

Results: Nine shoulders underwent a revision operation. The implant survival rate was 92% (95% confi-

dence interval, 77%-100%) at 10 years for total shoulder arthroplasty and 72% (95% confidence interval,

54%-97%) for hemiarthroplasty (Kaplan-Meier result). Patients who underwent total shoulder arthroplasty

had less pain (P ¼ .01), greater activeelevation (P ¼ .05), and higher satisfaction (P ¼ .05) at final follow-

up compared with those who underwent hemiarthroplasty. Complete radiographs were available for

47 arthroplasties with a minimum 2-year follow-up or follow-up until revision (mean, 6.6 years). More

than minor glenoid periprosthetic lucency or a shift in component position was present in 10 of 34 total

shoulder arthroplasties. Moderate to severe glenoid erosion was present in 6 of 13 hemiarthroplasties.

Conclusions: This study indicates that there is intermediate- to long-term pain relief and improvement in

motion with shoulder arthroplasty in young patients with osteoarthritis. These results favor total shoulder

arthroplasty in terms of pain relief, motion, and implant survival.

Level of evidence: Level IV, Case Series, Treatment Study.

Ó 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.

Keywords: Total shoulder arthroplasty; osteoarthritis; glenohumeral arthritis; young patient

The question of how to best treat the young patient with

glenohumeral osteoarthritis has been a challenging issue.

Better functional results have been shown for patients with

osteoarthritis after receiving total shoulder arthroplasty

comparedwithhemiarthroplasty.2,6,8,13 However,wear of the

polyethyleneglenoidcomponent withsubsequent failuredue

to component loosening has been considered a relative

contraindication to performing total shoulder arthroplasty in

young patients with ostensibly higher physical demands.

This is in contrast to several studies that have not shown

agreater failureratefor total shoulder arthroplasty compared

with hemiarthroplasty in patients aged 50 years or

younger.3,19,20 Becauseimplant loosening islesscommon in

hemiarthroplasty, the equivalence is likely a result of the

number of early revision surgeries in patients receiving

hemiarthroplasties who had inadequate pain relief.15 The

*Reprint requests: Robert H. Cofield, MD, Department of Orthopedic

Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

E-mail address: [email protected] (R.H. Cofield).

J Shoulder Elbow Surg (2011) 20, 123-130

www.elsevier.com/locate/ymse

1058-2746/$ - see front matter Ó 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.

doi:10.1016/j.jse.2010.05.006

Shoulder arthroplasty in patients aged fifty-five years or

younger with osteoarthrit is

Robert Bartelt, MD, John W. Sperling, MD, Cathy D. Schleck, BS,Robert H. Cofield, MD*

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

Background: The younger patient with glenohumeral arthritis presents a challenge because of concerns

about activity and frequency of failure. The purpose of this study was to define the results, complications,

and frequency of revision surgery in this group.

Materials and methods: Between 1986 and 2005, 46 total shoulder arthroplasties and 20 hemiarthroplas-

tieswereperformed in 63 patientswho wereaged 55 yearsor younger and had chronic shoulder pain dueto

glenohumeral osteoarthritis. All 63 patients had complete preoperative evaluation, operative records, and

minimum 2-year follow-up (mean, 7.0 years) or follow-up until revision.

Results: Nine shoulders underwent a revision operation. The implant survival rate was 92% (95% confi-

dence interval, 77%-100%) at 10 years for total shoulder arthroplasty and 72% (95% confidence interval,

54%-97%) for hemiarthroplasty (Kaplan-Meier result). Patients who underwent total shoulder arthroplasty

had lesspain (P ¼ .01), greater activeelevation (P ¼ .05), and higher satisfaction (P ¼ .05) at final follow-

up compared with those who underwent hemiarthroplasty. Complete radiographs were available for

47 arthroplasties with a minimum 2-year follow-up or follow-up until revision (mean, 6.6 years). More

than minor glenoid periprosthetic lucency or a shift in component position was present in 10 of 34 total

shoulder arthroplasties. Moderate to severe glenoid erosion was present in 6 of 13 hemiarthroplasties.

Conclusions: This study indicates that there is intermediate- to long-term pain relief and improvement in

motion with shoulder arthroplasty in young patients with osteoarthritis. These results favor total shoulder

arthroplasty in terms of pain relief, motion, and implant survival.

Level of evidence: Level IV, Case Series, Treatment Study.

Ó 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.

Keywords: Total shoulder arthroplasty; osteoarthritis; glenohumeral arthritis; young patient

The question of how to best treat the young patient with

glenohumeral osteoarthritis has been a challenging issue.

Better functional results have been shown for patients with

osteoarthritis after receiving total shoulder arthroplasty

comparedwithhemiarthroplasty.2,6,8,13 However,wear of the

polyethyleneglenoidcomponent withsubsequent failuredue

to component loosening has been considered a relative

contraindication toperforming total shoulder arthroplasty in

young patients with ostensibly higher physical demands.

This is in contrast to several studies that have not shown

agreater failureratefor total shoulder arthroplasty compared

with hemiarthroplasty in patients aged 50 years or

younger.3,19,20 Becauseimplant loosening islesscommon in

hemiarthroplasty, the equivalence is likely a result of the

number of early revision surgeries in patients receiving

hemiarthroplasties who had inadequate pain relief.15 The

*Reprint requests: Robert H. Cofield, MD, Department of Orthopedic

Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

E-mail address: [email protected] (R.H. Cofield).

J Shoulder Elbow Surg (2011) 20, 123-130

www.elsevier.com/locate/ymse

1058-2746/$ - see front matter Ó 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.

doi:10.1016/j.jse.2010.05.006

n= 66 (46 TSA, 20 HA), < 55 år

TSA mindre ont, bättre ROM, mer nöjda än HA

10-årsöverlevnad: 92% TSA vs 72% HA

Op av pat < 65 år fungerar bra

TSA och RSA

Fler komplikationer

Tålighet/förmåga att komma tillbaka/ motståndskraft

Protesval

Dynamisk stabilisering

Förtvinad muskel

Störd biomekanik

ROTATORKUFFARTROPATI

Statisk posterior subluxation

OMVÄND AXELPROTES

Paul Grammont, FRA

Utvecklad för

rotatorkuffartropati

Sedan 1993 i Europa

FDA godkände 2004

OMVÄND AXELPROTES

FÖRLÄNGNING AV ARMEN

Tre rehabspår efter axelprotes

Frakturprotes

Anatomisk/omvänd med sutur av subscap

Omvänd utan sutur av subscapularis

Komplikationer

Infektion 1%

Glenoidlossning anatomisk < 3%

Lossning humeruskomp omv. 1%

Luxation <1%

Fraktur acromion <1%

A-type: 2-part

B-type: 3-part

C-type: 4-part +

anatomic neck

AO Classification

Bone Joint J 2017;99-B:383–92

Konklusion: det är ingen skillnad i resultat att operera

jämfört icke-operation

Kritik: enbart 4 av 172 frakturer 4-fragmentsfrakturer

SOTS Stockholm 2018 – vi vet inte...

Axelproteskirurgi vid fraktur

Op inom 2 v efter trauma

HA oförutsägbara resultat relaterat till

tuberkelinläkning

RSA förutsägbara resultat som inte kräver

tuberkelinläkning eller intakt kuff

Bättre ER med läkt GT

Suturhantering

Tuberkelinläkning

Fraktur

Ingen kirurgi eller omvänd protes subakut

9/10 konservativ behandling

Ett mindre antal unga osteosyntes (eller hemi)…

Ord

HA Hemiartroplastik (halvprotes)

TSA Total shoulder arthroplasty (anatomisk total)

RSA Reverse SA (omvänd protes)

ER External rotation (utåtrotation)

GT Greater tubercle (tub majus)

2. f. einarsson axelprotes pv 2018

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