| HUMERAL
HEAD RESURFACING: A NEW APPROACH TO SHOULDER ARTHROPLASTY*
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BY Leonard
Bodell MD, Ronald B Joseph MD
ABSTRACT
The authors
will present 75 patients with many over eight years post-op
who have had humeral head resurfacing prosthesis for both
degenerative and rheumatoid arthritis.
Indications
are for humeral heads with reasonable contour. Rotator cuff
reconstruction or repair is done when needed. Cuff lateral
advancement is often carried out with subscapularis superior
transfer to better augment the rotator cuff effect. The prosthesis
is contra-indicated in significant osteoporosis.
When utilizing
the usual parameters of measuring prosthetic replacement,
the majority of results fall within good to excellent; ROM
falls in the good range with the major problems being some
residual impingement regardless of the amount of anterior
decompression which is carried out simultaneously. Strength
was rated as good and appeared to improve at the one to two
year mark as did the improvement in ROM.
Only two
prostheses were revised to a standard stemmed prosthesis and
a 10% post-op manipulation under general anesthesia was encountered.
Anterior capsular procedures for internal rotation contractures
with various lengthening techniques did not seem to alter
the need for manipulation. Manipulation dramatically improved
the ROM especially external rotation. Significant capsular
freeing is carried well inferior and posterior. Axillary nerve
dissection and neurolysis from the inferior capsule is carried
out in all cases.
In summary,
this is a safe, effective, pain relieving, and functionally
impressive procedure, with results which are reproducible.
No bridges are burned. Salvage is easily achieved if revision
is needed. The prosthesis is indicated in either osteo and
rheumatoid arthritis and contraindicated in osteoporosis.
Rotator cuff reconstruction is achieved at the same time when
needed.
*Published
Journal of Shoulder and Elbow Surgery, Jan 1994
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