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Planning and navigation in total shoulder arthroplasties

Published in N°271 - February 2018
Article viewed 270 times

Planning and navigation in total shoulder arthroplasties

By Pierre-Henri Flurin in category TECHNIQUE
Clinique du Sport Bordeaux-Mérignac

Clinical outcome after anatomical total shoulder arthroplasty (TSA) depends on the quality of restoration of the patient’s anatomy, which determines soft tissue stability and good biomechanical implant alignment.

Introduction

Clinical outcome after anatomical total shoulder arthroplasty (TSA) depends on the quality of restoration of the patient’s anatomy, which determines soft tissue stability and good biomechanical implant alignment. Durability of the implants also relies on correct orientation of the prosthetic components, which determines the balance of pressures exerted on the implants and their fixation to bone.1-3

Reverse prostheses must also observe the same precision in positioning to optimize the recovery of mobility but must also minimize the risk of implant instability. The rate of scapular notching has been clearly described as depending on both implant type and implant placement.4,5

The exacting nature of prosthetic shoulder implant placement is added to by the technical difficulty of installing them, which relates in part to restricted access during the surgical approach, but particularly to limitations and difficulties in perioperative assessment of the anatomical and mechanical axes. During the procedure, the surgeon’s only visual landmarks are the articular surface of the glenoid fossa and the base of the coracoid process, and the only landmarks for palpation consist of the scapular pillar and the anterior border of the glenoid. These are not at all adequate for...

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