“Shaped” humeral head autograft reverse shoulder arthroplasty

Shoulder arthroplasty (SA) has improved significantly over the last twenty years. It offers the effective treatment for patients with severe shoulder dysfunctions. The indications for this procedure have recently expanded tremendously. However, the most common are glenohumeral osteoarthritis, inflammatory shoulder arthropathies, rotator cuff-tear arthropathy, complex fractures of the proximal humerus and osteonecrosis of a humeral head. There is range of the procedures, such as resurfacing of humeral head, anatomic total shoulder arthroplasty, hemiarthroplasty and reverse shoulder arthroplasty. All of them could significantly improve patients quality of life. The outcomes of the shoulder arthroplasty are very satisfying in terms of pain relief and considerable improvements in shoulder function as well as in motion. However, this procedure is not so popular as knee or hip arthroplasties. The reasons for this phenomenon are not clear. The complication rate is considerably low. The most common are periprosthetic fractures, infections, implant loosening and instability. The reasonable solution is a conversion to reverse total shoulder arthroplasty. The survivorship of the prosthesis is up to 12 years, which is acceptable by patients. Long term result are still not clear. Surgeons performing SA opt for deltopectoral approach which provides good exposure of the joint also for revisions. The aim: To summarize knowledge about SA based on current literature.

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Multimodality imaging in shoulder arthroplasties Part 1: Biomechanics, indications, preoperative imaging, and types of arthroplasties – A pictorial review

Indian Journal of Musculoskeletal Radiology ◽

10.25259/ijmsr_26_2021 ◽

2021 ◽

Vol 3 ◽

pp. 24-29

Author(s):

Matthew Sarvesvaran ◽

Siddharth Thaker ◽

Suresh Srinivasan ◽

Rahatdeep Singh Brar ◽

Raj Bhatt ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Multimodality Imaging ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Preoperative Imaging ◽

Shoulder Biomechanics ◽

Case Examples ◽

Pictorial Review ◽

Shoulder Arthroplasties

Shoulder biomechanics, shoulder arthroplasty indications and types and appropriate pre-operative imaging are discussed in part one of this two-part pictorial review. Shoulder biomechanics in severe osteoarthritis and following reverse shoulder arthroplasty are represented graphically, with discussion on the principles of reverse shoulder arthroplasty. Case examples are utilized to demonstrate the main indications for shoulder arthroplasty. The decision of whether to proceed with arthroplasty and the arthroplasty type is heavily influenced by the pre-operative imaging. Factors for type of arthroplasty include arthroplasty indication, the integrity of the deltoid and rotator cuff musculature, and the amount of glenoid and humeral head bone stock. The key findings to look for and comment on across a range of imaging modalities are reviewed, using multiple cases including plain radiography, CT, ultrasound, and MRI. Examples of arthroplasty options are provided including humeral head resurfacing arthroplasty, hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty. A good understanding of the above principles is crucial for the radiologist to interpret pre-operative imaging correctly and aid in surgical planning.

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51 Reverse Shoulder Arthroplasty with a Shaped Humeral Head Autograft for B2/B3 and C Glenoids

Shoulder Surgery ◽

10.1055/b-0039-167700 ◽

2019 ◽

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Reverse Shoulder Arthroplasty

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Intrathoracic fracture-dislocation of the humeral head: A case report and review of the literature

10.32592/ircmj.2021.23.8.1248 ◽

2021 ◽

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Early Stage ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Multidisciplinary Treatment ◽

Fracture Dislocation ◽

Range Of Movement ◽

Multiple Fractures ◽

Emergency Thoracotomy

Background: Intrathoracic displacement of a humeral head fracture is extremely rare. Only slightly more than 30 cases have been reported in this regard. Since few cases have been reported, there is no consensus on how to treat this injury. The etiology, injury mechanism, related lesions, and treatment of the injury are diverse. Case presentation: A 73-year-old female presented with multiple fractures of the left ribs, bilateral lung contusions, extensive emphysema of the anterior and posterior chest wall, massive left hemopneumothorax, fracture-dislocation of the proximal humerus, and intrathoracic displacement of the humeral head. The patient was sent to the operating room for emergency thoracotomy surgery. The head of the humerus was confirmed to be completely removed from the thoracic cavity during the operation. After discussion with the orthopedic surgeon, the humeral head was discarded considering avascular necrosis; moreover, open reduction and internal fixation were not performed. The orthopedic surgery team performed reverse shoulder arthroplasty three weeks later. During follow-up, the patient’s shoulder was free from pain, and its range of movement included 110° flexion, 70° abduction, 35° external rotation, and 50° internal rotation. Conclusion: Intrathoracic displacement of the humeral head due to proximal humeral fracture is a very rare and serious trauma that requires multidisciplinary treatment. Considering the extremely high risk of humeral head necrosis, actively removing broken bone fragments of the humeral head in the early stage is recommended, and we advocate for shoulder arthroplasty for elderly patients. Detailed preoperative evaluations and individualized operation plans should be made to achieve the best effect.

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