Treatment of Glenohumeral Arthritis with a Hemiarthroplasty by Michael A. Wirth, R. Stacy Tapscott, Carleton Southworth, and Charles A. Rockwood JBJS Essent

Treatment of Glenohumeral Arthritis with a Hemiarthroplasty

by Michael A. Wirth, R. Stacy Tapscott, Carleton Southworth, and Charles A. Rockwood

JBJS Essent Surg TechVolume os-89(2 suppl 1):10-25

March 1, 2007

©2007 by The Journal of Bone and Joint Surgery, Inc.

The patient is positioned at the edge of the operating table in a beach-chair position with the head supported on a McConnell headrest (McConnell Orthopaedic Manufacturing, Greenville,

Texas).

Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25






The subscapularis is incised at its insertion to the lesser tuberosity (arrows) and is tagged with several 1-mm Cottony Dacron sutures (Deknatel, Fall River, Massachusetts).













Medial reattachment of the subscapularis tendon functionally lengthens the muscle-tendon unit by 1 to 2 cm, resulting in an improved range of motion.



The varus-valgus angle of humeral head resection is determined with an osteotomy template positioned in line with the long axis of the humeral shaft.













The lateral aspect of the subscapularis fossa at a point midway between the superior and lateral borders of the scapula is described as the “centering point.”.







Osteophytes are removed to increase exposure and to prevent motion-limiting abutment.



Ideally, drawer testing demonstrates 40% to 60% posterior translation of the humeral head relative to the center of the glenoid.



Achieving 75° to 90° of internal rotation is the goal when assessing soft-tissue balance with the arm positioned in 90° of abduction.



The hand is placed on the contralateral shoulder while the operatively treated shoulder is observed for protraction of the scapula.







Preoperative templating in this case should alert the surgeon to the possibility of suboptimal placement of the prosthetic head and “joint stuffing.”.



Computed tomography scan demonstrating approximately 30° of posterior glenoid erosion relative to the plane of the scapular body.







Carefully placed retractors help to identify the rotator cuff insertion and to protect the cuff integrity during humeral head resection.



Glenohumeral stability is suboptimal when the glenoid center line is not collinear with the net humeral joint reaction force.



Radiograph of a patient with persistent pain and stiffness following hemiarthroplasty.



Overstuffing of the shoulder joint secondary to an overly large humeral head component usually results in pain, shoulder stiffness, and compromise of the rotator cuff.



Documents

Treatment of Glenohumeral Arthritis with a Hemiarthroplasty by Michael A. Wirth, R. Stacy Tapscott, Carleton Southworth, and Charles A. Rockwood JBJS Essent