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Correct humeral head size is key to successful total shoulder arthroplasty
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WAIKOLOA, Hawaii — To have a successful total shoulder arthroplasty, orthopedic surgeons need to make sure the humeral head implant is the correct size, according to a presentation at Orthopedics Today Hawaii.
“It is very important to understand what your head size is. This is really critical to the procedure,” Anthony A. Romeo, MD, Orthopedics Today Chief Medical Editor, said here. “Be very careful about overstuffing the glenohumeral joint. Identifying the proper size is very important.”
Romeo said most shoulder arthroplasties are performed with the deltopectoral approach, with management of the subscapularis, capsule release, cutting of the humeral head, implant placement and closure of the wound.
“At the beginning of the case, what’s white is white and what’s red is red,” he said. “So, it is a nice time to find the capsule. [We] are separating out the capsule from the muscle and we are releasing it all the way down, despite the large osteophytes on the glenoid. That will give us nice exposure so that when we put the flat retractor across the glenohumeral joint, we can then dislocate the shoulder.”
Romeo added, “One of the keys to making sure you have the humerus in the right spot and that you’ve done the right cut, is that you can see the whole thing. So, when you do these types of releases, you can have the entire 360° view of the humerus and then you have a variety of options available. “
He said after the humeral head is off, it is important to have the right humeral implant size because everything below the humerus is there to keep it in place, despite the use of a short stem, long stem or no stem. The humeral head size needs to be correct because newer implants were designed to give patients full range of motion and activity.
“After you are done with the glenoid, you have to have a great strategy to repair the subscapularis. The functional result of your patient will be directly related to whether the subscapularis heals or not. It is not an afterthought,” Romeo said. – by Monica Jaramillo
Reference:
Romeo AA, et al. How to get the humerus perfect. Presented at: Orthopedics Today Hawaii; Jan. 13-17, 2019; Waikoloa, Hawaii.
Disclosure s : Romeo reports he receives royalties from Arthrex and Elsevier; is a consultant for Arthrex and receives miscellaneous support from Arthrex; receives basic science/research support from Arthrex, Smith and Nephew, Ossur, MioMed, DJ Ortho, ConMed Linvatech, Athletico; is on the editorial board for Orthopedics Today (Chief Medical Editor), Journal of Shoulder and Elbow Surgery, Techniques in Shoulder and Elbow, Techniques in Sports Medicine, Sports Health, Orthopedics; and received publisher support from Elsevier and Orthopedics Today.