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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
2100-11-401 Common Humeral Head 40 X 15 Trial
2100-11-402 Common Humeral Head 40 X 18 Trial
2100-11-440 Common Humeral Head 44 X 12 Trial
2100-11-441 Common Humeral Head 44 X 15 Trial
2100-11-442 Common Humeral Head 44 X 18 Trial
2100-11-443 Common Humeral Head 44 X 21 Trial
2100-11-481 Common Humeral Head 48 X 15 Trial
2100-11-482 Common Humeral Head 48 X 18 Trial
2100-11-483 Common Humeral Head 48 X 21 Trial
2100-11-521 Common Humeral Head 52 X 15 Trial
2100-11-522 Common Humeral Head 52 X 18 Trial
2100-11-523 Common Humeral Head 52 X 21 Trial
2100-11-562 Common Humeral Head 56 X 18 Trial
2100-11-563 Common Humeral Head 56 X 21 Trial
2100-22-401 Common Humeral Head 40 X 15 Eccentric Trial
2100-22-402 Common Humeral Head 40 X 18 Eccentric Trial
2100-22-441 Common Humeral Head 44 X 15 Eccentric Trial
2100-22-442 Common Humeral Head 44 X 18 Eccentric Trial
2100-22-443 Common Humeral Head 44 X 21 Eccentric Trial
2100-22-481 Common Humeral Head 48 X 15 Eccentric Trial
2100-22-482 Common Humeral Head 48 X 18 Eccentric Trial
2100-22-483 Common Humeral Head 48 X 21 Eccentric Trial
2100-22-521 Common Humeral Head 52 X 15 Eccentric Trial
2100-22-522 Common Humeral Head 52 X 18 Eccentric Trial
2100-22-523 Common Humeral Head 52 X 21 Eccentric Trial
2100-22-562 Common Humeral Head 56 X 18 Eccentric Trial
2100-22-563 Common Humeral Head 56 X 21 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
WOOS
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
Rehab
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)
