Hemiarthroplasty was popularized by charles neer, md, 1 and represented a significant advance in shoulder arthroplasty. Whenever we question surgeons who routinely perform hemiarthroplasty instead of total shoulder arthroplasty for conditions such as primary osteoarthritis about why they chose not to resurface the glenoid, by far the most common response is that they encounter problems with glenoid exposure. The purpose of this book was to offer an overview of recent insights into the. Clear, evidencebased coverage details which technology and methodology used for total shoulder arthroplasty, reconstruction or revision is best for. Femoral canal preparation use the box osteotome and canal finder for initial entry into femoral canal. Dec 10, 2019 shoulder hemiarthroplasty is a shoulder replacement in which the damaged humeral head is replaced with a prosthetic humeral head. Sep 06, 20 it is worth noting that outcomes for hemiarthroplasty are comparable with those in primary total shoulder arthroplasty in terms of pain, though functional improvement is greater following primary total shoulder arthroplasty. Attempts to solve the glenoid problem with interposed. It is not intended to be a substitute for special instructions from dr. Hip hemiarthroplasty arizona, scottsdale hip fracture.
The use of shoulder hemiarthroplasty and humeral head. Hip hemiarthroplasty ventura ca hip surgery ventura. Shoulder arthroplasty is a complex procedure that is becoming increasingly more. Although most proximal humerus fractures can be treated nonoperatively, 4part fractures and 3part fracturesdislocations in elderly patients often require management with prosthetic arthroplasty.
Infection rates after shoulder arthroplasty are relatively low. Apr 19, 2011 one patient required early revision surgery. Stepbystep, evidencebased guidance walks you through both common and unique cases youre likely to see in your practice, while tips. The jbjs has published a recent version of the technique here. Shoulder arthroplasty is a rapidly evolving area of orthopedics focused on treating specific, painful ailments of the glenohumeral articulation. This masterful book from top experts provides clinical insights.
Revision rates and quality of life indicators are also comparable to that of total shoulder prostheses. It covers followup exams, medication refills, and when to call your doctor or nurse. Surgical approaches in shoulder arthroplasty intechopen. Shoulder arthroplasty for proximal humerus fractures. Description a surgical procedure in which the humeral articular surface is replaced without attention to the glenoid side of the joint. The procedure is performed under general anaesthesia. Partial hip replacement also called hip hemiarthroplasty is a surgical technique employed to treat hip fractures.
By using the anatomic landmarks referenced during preoperative xray templating, the preplanned neck resection is made with an oscillating saw and with the aid of the neck resection guide. The aim of this book chapter is to describe the methodology for approaching. Written by leading shoulder specialists, the book provides surgeons and rehabilitation. May 29, 2016 shoulder hemiarthroplasty young lae moon. Success in shoulder arthroplasty surgery is not necessarily dependent only on the principle of construction of a prosthetic device nor the way. The clinical outcome of hemiarthroplasty for proximal humeral fractures is not satisfactory. Revision shoulder arthroplasty is a complex procedure that requires precise planning.
The exposure and the humeral side of the arthroplasty. The shoulder hemiarthroplasty is used to replace a humeral head that has been damaged by a fracture, a vascular necrosis of known or unknown cause, or a destructive tumor. Complex issues in the primary and revision setting assembles the clinical knowledge of leading orthopedic surgeons treating patients with arthritic shoulders. With modern cementing techniques, the rate of glenoid radiographic loosening is. Management of failed hemiarthroplasty with reverse. Jun 02, 2008 should jordan henderson win the pfa player of the year award. A displaced fragment is defined as one with displacement of more than 1 cm or angulation of more than 45 degrees fig. Focusing on all key aspects of shoulder replacement surgery and emphasizing the latest techniques and tools, shoulder arthroplasty, 2nd edition, brings you expert procedural approaches from two master surgeons in the field. Francis mendoza will explain when a shoulder hemiarthroplasty is recommended. Suture technique and closure instrumentation the latitude surgical technique has been developed in conjunction with. It features a true anatomical reconstruction of the joint, modular components, and is adaptable to a wide range of indications.
Neviaser brings you up to speed with mustknow surgical techniques in todays technically demanding shoulder and elbow surgery. Precise surgical technique is critical for success, with proper tension of capsular, muscular, and tendinous surfaces needed for stability. Rehabilitation for total shoulder replacement part i. A humeral hemiarthroplasty is not the same as a ream and run. The objective of this article is to describe the surgical technique for revising a shoulder hemiarthroplasty into a reverse prosthesis. Although humeral hemiarthroplasty can provide good results, there is some evidence that the comfort and function is less than a successful total shoulder arthroplasty. There are several conditions that can lead patients to consider shoulder joint replacement surgery. In this procedure, only one half ball section of the hip joint is substituted by a metal prosthesis. Technical pitfalls of shoulder hemiarthroplasty for fracture. The rehabilitation protocol for total shoulder arthroplasty tsa hemiarthroplasty hhr is based on the latest research. A french surgeon, paean, was the first to implant a shoulder prosthesis in 1893.
Stateofthe art techniques for shoulder replacement surgery. Based on the patients surgical procedure, other therapeutic exercises might be encouraged by. Conversion of failed hemiarthroplasty to reverse total. Hip hemiarthroplasty surgery houston, tx hip fracture.
Description a surgical procedure in which the humeral articular surface is replaced without. The most common complications following primary hemiarthroplasty for proximal humerus fractures relates to surgical technique. While enthusiasm for hemiarthroplasty has waned, especially in the setting of osteoarthritis, the painful hemiarthroplasty continues to be a frequent presenting complaint in the shoulder specialists office. Since the popularization of shoulder hemiarthroplasty by neer in the 1950s, shoulder arthroplasty has been performed with increasing frequency, with more than 27,000 total shoulder arthroplasties tsas and 20,000 hemiarthroplasties has performed in the united states in 2008 alone. Shawn odriscoll, md, phd mayo foundation, ken yamaguchi, md washington university, barnes jewish hospital graham king, md, msc university of western ontario 2 table of contents table. Superior migration of the prosthesis can still occur due to rotator. Surgical technique prepare acetabulum if acetabular reconstruction is required, prepare the acetabulum using the surgical technique for the intended acetabular component.
Pdf i surgical approaches for shoulder arthroplasty. Revision to reverse shoulder arthroplasty is a feasible option in properly selected patients. Technical pitfalls of shoulder hemiarthroplasty for. Currently, surgeons debate the indications for and results of total. The hip joint is one of the bodys largest weightbearing joints and is the point where the thigh. Feb 23, 2017 technical pitfalls of shoulder hemiarthroplasty for fracture management although most proximal humerus fractures can be treated nonoperatively, 4part fractures and 3part fracturesdislocations in elderly patients often require management with prosthetic arthroplasty. As shoulder arthroplasty is increasing, the expected amount of revisions is expected to increase accordingly. Position the patient so the involved shoulder extends over the top corner and edge of the table figures 6a and b. Proximal humerus fracture book twin cities orthopedics. An incision is made along the outer aspect of the affected hip. Problems with prosthetic glenoid components are loosening and wear. Hip hemiarthroplasty south bend hip fracture treatment. Total shoulder arthroplastyhemiarthroplasty protocol.
Surgical technique figure 6b the involved shoulder should extend over the table edge. The actual post surgical physical therapy management must be based on the surgical approach, physical examfindings, individual progress, andor the presence of postoperative complications. Failure to anatomically secure the tuberosities, restore the humeral height, and recreate the appropriate humeral retroversion are the most likely reasons for failure. Secondary fragment dislocation may prevent bone integration. The surgeon gains access to the hip joint and the head of the femur is removed using surgical instruments and prepared to accept the prosthesis. It was originally designed as an uncemented implant.
Hemiarthroplasty shoulder surgery understanding your treatment plan this handout explains care after your shoulder surgery while you are in the hospital, and also details care issues while you recover at home. Stepbystep, evidencebased guidance walks you through both common and unique cases youre likely to see in your practice, while. His early work with proximal humerus fractures provided him with the experience to use the same concepts to treat shoulder osteoarthritis oa. The axial starter reamer is used with the thandle to open the femoral canal and to aid in determining the orientation of the femoral axis. It wasnt until neers work in the 1950s however that shoulder arthroplasty began to truly develop. A trauma hemiarthroplasty system combined with good surgical technique can ensure tuberosity fixation and subsequent union. Hemiarthroplasty does not disturb the glenoid and is a lesser procedure. Hip hemiarthroplasty is a surgical technique employed to treat hip fractures. The book provides stateoftheart information on implant design and detailed guidelinesincluding treatment algorithmson specific arthroplasty procedures for arthritis, fractures, chronic dislocations, and other disorders. Hemiarthroplasty is a technically easier and faster procedure than total. Paff, or clinical decision making regarding the pro. Galatz, in case competencies in orthopaedic surgery, 2017.
This chapter details this commonly used surgical approach to the glenohumeral joint. There are various indications for shoulder hemiarthroplasty. Here is a technique intensive textbook of shoulder arthroplasty detailing how to handle all relevant aspects of shoulder replacement surgery. The objective of this article is to describe the surgical technique for revising a. A hemiarthroplasty procedure results in less surgical time and less blood loss than a thr. Fractures are extremely rare with the impaction bone grafting technique.
The first is an arthritic shoulder where the socket is not in bad condition, but the ball needs to be replaced. Stepbystep, evidencebased guidance walks you through both common and unique cases. Shoulder hemiarthroplasty for fractures of the proximal humerus. Neviaser brings you up to speed with mustknow surgical techniques in todays technically demanding shoulder and elbow surg. Not only will it help to reduce your current symptoms it will provide a solid platform for post surgical rehabilitation speeding up your rehab period and allowing you to maximise your rehab potential. Total shoulder arthroplasty a general description can be seen here. Part of the practical, highly illustrated operative techniques series, this fully revised title by drs. Shoulder hemiarthroplasty ha is indicated in patients with displaced and comminute fractures, where avascular necrosis of the humeral head seems inevitable.
Orthopedic secrets fourth edition, 2015 related terms. Shoulder hemiarthroplasty with nonprosthetic glenoid. Sep 16, 2019 the reverse shoulder replacement was designed for that issue. Immediate motion weeks 0 to 8 goals allow early healing of capsule increase passive range of motion decrease shoulder pain retard muscular atrophy and prevent rotator cuff inhibition brace discontinue use after six to eight weeks unless otherwise advised by dr.
Since its introduction, this prosthesis has remained a popular implant in the management of hip fractures. To see more of the shoulder arthritis book, click here. The shoulder hemiarthroplasty is most often performed for one of three reasons. In a multicenter retrospective analysis, we analyzed 274 revision shoulder arthroplasties converted to a rsa n 182, anatomic total shoulder arthroplasty tsa, n 68, or. This protocol was adapted from the articles titled. Background shoulder hemiarthroplasty is a shoulder replacement in which the broken humeral head is replaced with an artificial joint and the fractured bone is reconstructed around the artificial joint. Shoulder hemiarthroplasty an overview sciencedirect topics. It features a true anatomical reconstruction latitude total elbow prosthesis of the joint, modular components, and is adaptable to a wide range of indications. Initial firstgeneration designs for total shoulder replacements were constrained, meaning the humeral and glenoid components were mechanically coupled around a fixed center of rotation. Hip hemiarthroplasty surgery royal oak femoral neck. The hip joint is one of the bodys largest weightbearing joints and is the point where the thigh bone femur and the pelvis acetabulum unite. Revision to a reverse shoulder replacement is a viable salvage option in these patients. A surgeon must decide between a hemiarthroplasty or a total shoulder arthroplasty when performing shoulder replacement surgery.
Shoulder hemiarthroplasty physical therapy protocol phase i. Present technical comparison of surgical fixation techniques reveals the stateoftheart approach and highlights promising techniques for. Success in shoulder arthroplasty surgery is not necessarily dependent only on. Hemiarthroplasty for fracture neer type shoulderdoc by. Pdf shoulder arthroplasty is most commonly performed via a deltopectoral dp or anterosuperior as approach, and several modifications.
While use of an axial starter reamer is needed, use of cylindrical reamers is not necessary to prepare the femoral canal. Shoulder hemiarthroplasty physical therapy protocol. There may be less of a chance of hip dislocation following a hemiarthroplasty compared to a thr, too. Total shoulder arthroplastyhemiarthroplasty protocol phase i. Use a drape to isolate the anesthesia equipment from the sterile field. The book presents practical approaches to surgically managing each type of arthritis, the. Present technical comparison of surgical fixation techniques reveals the stateoftheart approach and highlights promising techniques. The recovery from a reverse total shoulder is much different than recovery from an orif, intramedullary rod, or hemiarthroplasty. Shoulder and elbow surgery a title in the operative techniques seriesoffers you the stepbystep guidance you needon slap reconstruction, total shoulder arthroplasty, humerus fractures, and morefrom experts donald lee and robert neviaser. Shoulder hemiarthroplasty replaces half of the joint. Written by the worlds foremost shoulder and elbow surgeons, this volume is the most comprehensive, current reference on shoulder and elbow arthroplasty.
Dec 10, 2019 background shoulder hemiarthroplasty is a shoulder replacement in which the broken humeral head is replaced with an artificial joint and the fractured bone is reconstructed around the artificial joint. Reverse arthroplasty is gaining in popularity, but hemiarthroplasty still has a role in the management of 4part and some 3part fractures and dislocations. The definitive book on reverse shoulder arthroplasty from leading orthopaedic shoulder surgeons. Thompson hemi hip stem surgical technique depuy synthes 1 introduction the thompson hemiarthroplasty was first reported in the mainstream orthopaedic literature in 1954. Glenoid wear is a particular risk when the quality of the bone is poor or when the glenoid surface is not congruent with the humeral prosthesis. What are some of the indications of shoulder hemiarthroplasty. Surgical technique is a critical variable in the success of any arthroplasty. The video journal of orthopaedics has provided a short view of the technique. Hemiarthroplasty for fracture neer type neer developed a foursegment classification system, which remains the standard for the evaluation and treatment of these injuries. The procedure is performed under general anesthesia. A step by step approach to the ream and run is shown here. A video including the surgical technique and patient interview can be found here.