Shoulder Hemiarthroplasty

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Osteoarthritis with intact glenoid articular cartilage
  • Osteonecrosis of the humeral head
  • Rotator cuff arthropathy
  • Inadequate glenoid bone to hold glenoid prosthesis
  • Age less than 50 years
  • Patients who require heavy physical activity
CONTRAINDICATIONS
  • Osteoarthritis with significant glenoid cartilage loss
  • Incongruent glenohumeral osseous surfaces
  • History of joint infection
  • Current systemic infection
  • Paralytic disorder of the shoulder
  • Deltoid and rotator cuff dysfunction
EQUIPMENT
  • McConnell headrest
  • Richardson retractors
  • Self-retaining retractors
  • Electrocautery
  • Elevators
  • Scofield-type retractor
  • No. 2 braided nonabsorbable sutures
  • Small bone hook
  • Large Darrach retractor
  • Humeral osteotomy template
  • Air bur
  • Glenoid reamer
  • Oscillating saw
  • Rongeurs
  • Suture passers
  • Large curved modified Crego retractor
  • Sagittal power saw
  • Medullary canal reamers
  • Drill
  • Body-sizing osteotome
  • Intramedullary rod
  • Osteotomes
  • Mallet
  • Humeral broaches and implants of various sizes
  • Implant drivers and extractors
  • Cement (optional)
  • Antibiotic solution for irrigation
  • Absorbable suture for closure
  • 1/8-inch suction drain
  • 0.50% bupivacaine solution.
ANATOMY
  • The shoulder joint is typically described as a ball-and-socket joint but without the bony congruity associated with the hip joint.
    • The humeral head is essentially spherical with an arc of approximately 160 degrees, It is covered by articular cartilage. Radius of curvature is approximately 25 mm and is slightly larger in men than in women.
    • Humeral neck-shaft angle averages 45 degrees.
    • Glenoid: articular surface radius of curvature is 2 to 3 mm larger than that of the humeral head.
    • Glenoid surface: ranges from 2 degrees of anteversion to 7 degrees of retroversion in relationship to the scapular body
  • Stability and motion of the joint are dependent on the static and dynamic stabilizers.
    • Rotator cuff muscles
    • Deltoid muscle
    • Joint capsule
    • Superior, middle, and inferior glenohumeral ligaments.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Immobilize the shoulder for 4 to 5 days postoperatively, then apply a sling.
  • Discharge the patient from the hospital 2 to 3 days after surgery, but schedule follow-up approximately 2 weeks later.
  • Progress physical therapy slowly, concentrating on passive range of motion early.
    • Begin active-assist range-of-motion and isometric exercises when the sling is applied and continue these for the first 6 weeks.
    • Avoid active flexion and abduction and discourage aggressive passive stretching for the first 6 weeks.
    • Begin supine external rotation exercises at 4 to 5 days.
    • Add pendulum exercises at 7 days.
    • Begin horizontal external rotation exercises at 14 to 16 days.
    • Add isometric exercises for the internal and external rotators and the middle and posterior thirds of the deltoid at 17 to 21 days.
    • Resistive exercises may be added as strength improves.
    • Maximal rehabilitation most likely will not be complete until 18 to 24 months.
COMPLICATIONS
  • Intraoperative complications
    • Fracture of the humerus, usually the humeral shaft or tuberosities
    • Nerve injury
    • Component malposition
  • Postoperative complications
    • Infection
    • Deltoid muscle dysfunction
  • Late complications
    • Component loosening
    • Periprosthetic fracture
    • Instability
    • Rotator cuff tear
    • Heterotopic ossification
    • Shoulder stiffness
RESULT ANALYSIS

Hemiarthroplasty has been associated with high patient satisfaction and low complication rates when appropriate patients are selected. When both the glenoid and the humeral sides of the joint are involved, total shoulder arthroplasty has better outcomes and is the surgery of choice for these patients.

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