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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.
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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
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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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).
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Medial reattachment of the subscapularis tendon functionally lengthens the muscle-tendon unit by 1 to 2 cm, resulting in an improved range of motion.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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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.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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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.”.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Osteophytes are removed to increase exposure and to prevent motion-limiting abutment.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Ideally, drawer testing demonstrates 40% to 60% posterior translation of the humeral head relative to the center of the glenoid.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Achieving 75° to 90° of internal rotation is the goal when assessing soft-tissue balance with the arm positioned in 90° of abduction.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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The hand is placed on the contralateral shoulder while the operatively treated shoulder is observed for protraction of the scapula.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Preoperative templating in this case should alert the surgeon to the possibility of suboptimal placement of the prosthetic head and “joint stuffing.”.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Computed tomography scan demonstrating approximately 30° of posterior glenoid erosion relative to the plane of the scapular body.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Carefully placed retractors help to identify the rotator cuff insertion and to protect the cuff integrity during humeral head resection.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Glenohumeral stability is suboptimal when the glenoid center line is not collinear with the net humeral joint reaction force.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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Radiograph of a patient with persistent pain and stiffness following hemiarthroplasty.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.
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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.
Michael A. Wirth et al. J Bone Joint Surg Am 2007;os-89:10-25
©2007 by The Journal of Bone and Joint Surgery, Inc.