From OT Europe

Challenges in shoulder arthroplasty: How to decide on treatment

EFORT

Reverse total shoulder arthroplasty was introduced in 1987 in Europe and nearly 20 years later in the United States. Since then, the number of reverse TSAs performed annually has increased worldwide. In 2015, the number of reverse TSAs performed surpassed that of hemiarthroplasties in the health care system. Conventional shoulder arthroplasty places the implant cup into the shoulder glenoid and the metal ball into the humerus. In reverse TSA, both parts of the implant are switched.

Although initially the main indication for reverse TSA was rotator cuff tears, many difficult shoulder problems are now treated with this type of arthroplasty. The initial results were obtained with a nonanatomic reverse prosthetic design with the center of rotation of the joint situated at the glenoid and with a nonanatomical humeral neck-shaft angle of 155° instead of 135°. This specific implant was fixed through the anterolateral transdeltoidal approach. Recently, controversies have emerged regarding the clinical results and the optimal configuration of these prostheses and the surgical techniques.

This Interactive Expert Exchange (IEE) session will discuss the improvements in prosthesis design, the importance of the surgeon’s experience and the clinical procedures that are necessary to optimize reverse TSA for the different shoulder conditions.

Lisbon Banner

Friday 7 June 2019 | 10:00 to 12:15
Challenges In Shoulder Arthroplasty

Introduction and conclusions

Lieven De Wilde (Belgium)

Presentations & Questions

Risk for Scapular Impingement After RTSA | Didier Poncet (France)

Risk of Glenosphere Disengagement in RTSA | Philippe Debeer (Belgium)

Impact of the Size of the Glenosphere on the Range of Motion And Influence of Instructions/Restrictions | Carlos Torrens (Spain)

Long or Short Stem With Adaptable Inclination Humeri? | Ofer Levy (United Kingdom)

Impact of the Humeral Head Osteotomy in RTSA: Anatomical Inclination Vs Non-Anatomical Inclination at the Humerus? | Andreas Marc Mueller (Switzerland)

Clinical Cases - Discussion

Speakers of this IEE panel will discuss the indications and outcomes of techniques they use on a daily basis to treat several shoulder disorders using reverse TSA, as well as give their personal hints on how implant design can influence the risk of scapular notching, disengagement and even the need for revision. The program of the session will also highlight how the size of the glenosphere can change the range of motion in reverse TSA and how the standard rehabilitation protocol should be adapted. Finally, together with the audience, each specific procedure will be analyzed in relation to several clinical cases, and discussion around all possible potential benefits for patients will wrap up this experts’ exchange.

IEE banner

As of this year, the IEE sessions can be attended by any participant who is fully registered for the EFORT Congress without any extra fee to be paid. All details to sign-up for the Lisbon meeting are available on the EFORT Congress registration platform. Join the session and challenge the experts.

EFORT

Reverse total shoulder arthroplasty was introduced in 1987 in Europe and nearly 20 years later in the United States. Since then, the number of reverse TSAs performed annually has increased worldwide. In 2015, the number of reverse TSAs performed surpassed that of hemiarthroplasties in the health care system. Conventional shoulder arthroplasty places the implant cup into the shoulder glenoid and the metal ball into the humerus. In reverse TSA, both parts of the implant are switched.

Although initially the main indication for reverse TSA was rotator cuff tears, many difficult shoulder problems are now treated with this type of arthroplasty. The initial results were obtained with a nonanatomic reverse prosthetic design with the center of rotation of the joint situated at the glenoid and with a nonanatomical humeral neck-shaft angle of 155° instead of 135°. This specific implant was fixed through the anterolateral transdeltoidal approach. Recently, controversies have emerged regarding the clinical results and the optimal configuration of these prostheses and the surgical techniques.

This Interactive Expert Exchange (IEE) session will discuss the improvements in prosthesis design, the importance of the surgeon’s experience and the clinical procedures that are necessary to optimize reverse TSA for the different shoulder conditions.

Lisbon Banner

Friday 7 June 2019 | 10:00 to 12:15
Challenges In Shoulder Arthroplasty

Introduction and conclusions

Lieven De Wilde (Belgium)

Presentations & Questions

Risk for Scapular Impingement After RTSA | Didier Poncet (France)

Risk of Glenosphere Disengagement in RTSA | Philippe Debeer (Belgium)

Impact of the Size of the Glenosphere on the Range of Motion And Influence of Instructions/Restrictions | Carlos Torrens (Spain)

Long or Short Stem With Adaptable Inclination Humeri? | Ofer Levy (United Kingdom)

Impact of the Humeral Head Osteotomy in RTSA: Anatomical Inclination Vs Non-Anatomical Inclination at the Humerus? | Andreas Marc Mueller (Switzerland)

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Clinical Cases - Discussion

Speakers of this IEE panel will discuss the indications and outcomes of techniques they use on a daily basis to treat several shoulder disorders using reverse TSA, as well as give their personal hints on how implant design can influence the risk of scapular notching, disengagement and even the need for revision. The program of the session will also highlight how the size of the glenosphere can change the range of motion in reverse TSA and how the standard rehabilitation protocol should be adapted. Finally, together with the audience, each specific procedure will be analyzed in relation to several clinical cases, and discussion around all possible potential benefits for patients will wrap up this experts’ exchange.

IEE banner

As of this year, the IEE sessions can be attended by any participant who is fully registered for the EFORT Congress without any extra fee to be paid. All details to sign-up for the Lisbon meeting are available on the EFORT Congress registration platform. Join the session and challenge the experts.