Arthrex TSA IOT Flashcards
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Questions and Answers

How much variable angulation of screw placement is provided by the locking bushings in the proximal humeral fracture suture plate?

60

When cementing the univers shoulder fracture system stem, which statement is correct?

  • After reaming, the stem is up-sized by 1 before implantation.
  • The reaming, the stem is down-sized by 1 before implantation. (correct)
  • The univers shoulder fracture system stem is not indicated for cemented implantation.
  • The humerus is reamed line to line with the size of the stem to be implanted.

    • What is the correct recommendation for arm position in abduction for SCR to obtain appropriate tensioning of the graft?

    20-30 deg

    What is the thickness of the recommended AFLEX dermal allograft for the SCR technique?

    <p>3.0mm</p> Signup and view all the answers

    Prior to uploading to VIP, CT scans must be compressed.

    <p>True</p> Signup and view all the answers

    Why would a CA humeral head be indicated instead of RTSA?

    <p>Deltoid insufficiency</p> Signup and view all the answers

    All of the following are mandatory information for the new VIP case except:

    <p>Date of CT scan</p> Signup and view all the answers

    Which of the legs of the VIP targeted overhang the glenoid surface?

    <p>Anterior-superior and anterior-inferior</p> Signup and view all the answers

    How many cage screw lengths are available in the Eclipse system?

    <p>4</p> Signup and view all the answers

    Preparation of the humeral canal for the univers shoulder fracture system stem includes?

    <p>Reaming to size and implantation of the stem</p> Signup and view all the answers

    What is the turnaround time to receive the glenoid targeted coordinates after approval for the VIP plan?

    <p>48 hours</p> Signup and view all the answers

    The adjustable height of the Arthrex univers FX system stem is best described as providing?

    <p>+/- 7.5mm of adjustable height</p> Signup and view all the answers

    Wolff's law regarding bone states?

    <p>Changes in stress lead to adaptation in bone</p> Signup and view all the answers

    Which patient would NOT be a good candidate for percutaneous pinning of a proximal humeral fracture?

    <p>Patient with a high likelihood for AVN</p> Signup and view all the answers

    Humeral articular cartilage makes up how much of the humeral head sphere?

    <p>1/3</p> Signup and view all the answers

    Is there a constant ratio between the humeral head diameter of the sphere and the height of the articular cartilage?

    <p>True</p> Signup and view all the answers

    Where is the approximate line of humeral head osteotomy?

    <p>the anatomic neck</p> Signup and view all the answers

    How many degrees of retroversion occur anatomically and where?

    <p>30 - 10 at elbow and 20 at humeral head</p> Signup and view all the answers

    What are the 4 main glenoid morphological considerations?

    <p>depth, version, inclination, anatomic position w/ respect to the rest of the scapula</p> Signup and view all the answers

    What can cause changes to the 4 main morphological considerations?

    <p>arthritis on glenoid can cause changes in depth, version, inclination, anatomic position w/ respect to the rest of the scapula</p> Signup and view all the answers

    What does the Walch Classification describe?

    <p>glenoid arthritic changes</p> Signup and view all the answers

    What does Walch Classification A represent?

    <p>humeral heads are centered in the glenoid</p> Signup and view all the answers

    What does Walch Classification A1 indicate?

    <p>no glenoid erosion, humeral head is in the center of the glenoid</p> Signup and view all the answers

    What does Walch Classification A2 indicate?

    <p>humeral head is centered in the glenoid, major glenoid erosion</p> Signup and view all the answers

    What does Walch Classification B represent?

    <p>humeral heads are subluxed posterior</p> Signup and view all the answers

    What does Walch Classification B1 indicate?

    <p>posterior subluxed humerus, narrowing G-H often due to subchondral sclerosis</p> Signup and view all the answers

    What does Walch Classification B2 indicate?

    <p>posterior subluxed humerus, retroverted glenoid, posterior rim erosion, posterior erosion of glenoid causing a definitive paleo-glenoid and neo-glenoid</p> Signup and view all the answers

    What does Walch Classification C signify?

    <blockquote> <p>25 degrees of retroversion regardless of erosion, dysplastic glenoid</p> </blockquote> Signup and view all the answers

    What is the most common glenoid wear pattern in shoulder osteoarthritis (OA)?

    <p>retroversion / posterior wear</p> Signup and view all the answers

    What are the hallmarks of osteoarthritis (OA) visible on X-rays?

    <p>osteophytes, subchondral cysts, joint space narrowing</p> Signup and view all the answers

    What is the most common type of shoulder arthritis?

    <p>OA</p> Signup and view all the answers

    What is the most common surgical approach for total shoulder arthroplasty (TSA) or reverse TSA (RTSA)?

    <p>Deltopectoral approach</p> Signup and view all the answers

    What are the hallmarks of rotator cuff arthropathy?

    <p>Severe RTC muscle atrophy and degeneration on CT scan/MRI, humeral head elevation on x-ray, intact axillary nerve conduction on EMG/nerve conduction study, decreased acromio-humeral distance</p> Signup and view all the answers

    When the humeral head was not positioned anatomically, the glenoid was 6.6 times more likely to require removal.

    <p>True</p> Signup and view all the answers

    Glenoid implant failure is dependent on the position of the humeral component and can change survival from 13 years when positioned anatomically to 8 years when positioned otherwise.

    <p>True</p> Signup and view all the answers

    What is retroversion?

    <p>turning backward, posterior angulation of the glenoid, towards acromion</p> Signup and view all the answers

    What is anteversion?

    <p>turning forward, anterior angulation of the glenoid, towards coracoid</p> Signup and view all the answers

    Inclination is also called what?

    <p>neck shaft angle, neck angle in regards to humeral axis</p> Signup and view all the answers

    What is the inclination range?

    <p>115-148</p> Signup and view all the answers

    What is the inclination sweet spot?

    <p>125-140</p> Signup and view all the answers

    What is the anatomic average inclination?

    <p>132.5</p> Signup and view all the answers

    Superior Escape is the result of what dysfunctional muscle/tendon?

    <p>supra</p> Signup and view all the answers

    Anterior Escape is the result of what dysfunctional muscle/tendon?

    <p>subscap</p> Signup and view all the answers

    What causes posterior escape?

    <p>glenoid erosion, posterior capsular laxity, overtightening of labrum-capsule</p> Signup and view all the answers

    What is humeral head escape?

    <p>Humeral head is no longer centered anatomically in the glenoid and is subluxed</p> Signup and view all the answers

    What is version?

    <p>rotation of the humerus in relation to the neutral glenoid, as well as the alignment or angulation of the glenoid face in relation to the neutral scapula. Average retroversion is 30. More retroversion can occur from arthritic changes.</p> Signup and view all the answers

    Where is the center of rotation (COR) for the humeral head?

    <p>Biomechanically fixed point with zero velocity as the humerus rotates within the G-H joint, directly in line with the lesser tuberosity</p> Signup and view all the answers

    What kind of location does the humeral head COR have?

    <p>Natural medial-posterior offset</p> Signup and view all the answers

    Arthrex Univers II gelons have a ____ offset because of ____?

    <p>3.5mm offset because COR has a natural medial-posterior offset</p> Signup and view all the answers

    What is Glenohumeral Mismatch?

    <p>Relationship/difference in the radius of humeral head and glenoid components.</p> Signup and view all the answers

    What is the Varus (Latin for crooked) implant?

    <p>When the implant is not centered in canal but distal aspect of the humerus is midline to the distal prosthesis. Causes stress/fractures, goal to put in neutral or valgus alignment.</p> Signup and view all the answers

    What are the main points of the Univers II & Apex system regarding 3-dimensional anatomic adaptability in the humeral canal?

    <ol> <li>inclination 125-140 deg, 2. version +/- 10 deg, 3. 3.5mm offset</li> </ol> Signup and view all the answers

    What is the material used for glenoid poly?

    <p>UHMWPE</p> Signup and view all the answers

    What are the 3 options for TSA glenoid poly?

    <ol> <li>Pegged (cement), 2. Keel (cement), 3. Vault lock (press fit/cement)</li> </ol> Signup and view all the answers

    What are the characteristics of keeled TSA glenoid poly?

    <ul> <li>has the fin, - two 6mm holes are drilled, - Allows for greater cement integration and anchoring into the vault...</li> </ul> Signup and view all the answers

    What is the size, thickness and keel length of keeled TSA glenoid poly?

    <p>S-XL, 4mm thickness, 13.5 length of keel...</p> Signup and view all the answers

    What material is pegged TSA glenoid poly made of?

    <p>UHMWPE</p> Signup and view all the answers

    What are the benefits of Vaultlock glenoid poly?

    <ul> <li>Finned central peg, - Facilitates immediate fixation, - Reduces OR time...</li> </ul> Signup and view all the answers

    What is the significance of the radius of curvatures in Vaultlock glenoid poly?

    <ul> <li>Glenoid anatomy variation-particularly impacts bone preservation, must ream depending on what ROC glenoid.</li> </ul> Signup and view all the answers

    What is the glenoid vault's role in TSA?

    <p>It provides stability for glenoid poly.</p> Signup and view all the answers

    What is the average length of a TSA stem measured by?

    <p>Length of stem is measured center of inclination block to the distal tip.</p> Signup and view all the answers

    What is the common issue with TSA?

    <ul> <li>Too small of head- unstable; - Too large of head- overstuffed joint...</li> </ul> Signup and view all the answers

    What is the goal of a stem in TSA?

    <p>Provide anatomic humeral head replacement</p> Signup and view all the answers

    What are the sizes of Univers apex stems?

    <ul> <li>5 to 15mm, length: 5-12 x 60; 5 no inclination variability.</li> </ul> Signup and view all the answers

    How is the length of a stem defined?

    <p>Length of the stem is measured from the center of inclination block to the distal tip.</p> Signup and view all the answers

    What group of prior surgeries is the most common cause of capsulorraphy arthropathy?

    <p>GH joint stabilization</p> Signup and view all the answers

    What is the average humeral retroversion that is reproduced during shoulder arthropathy?

    <p>30</p> Signup and view all the answers

    What are the 3 hallmarks of OA seen on X-ray?

    <p>osteophytes, subchondral cysts, joint space narrowing</p> Signup and view all the answers

    What vascular structure is found at the deltopectoral interval?

    <p>cephalic vein</p> Signup and view all the answers

    What nerve innervates the deltoid muscle?

    <p>axillary</p> Signup and view all the answers

    Which muscle/tendon can be incised 1-1.5cm to help expose during shoulder arthroscopy?

    <p>pectoralis major</p> Signup and view all the answers

    What is the offset of the heads in the Univers II total shoulder?

    <p>3.5mm</p> Signup and view all the answers

    Which of the following is a key feature of the Univers II and Apex TSA systems?

    <p>125-140 deg inclination variability</p> Signup and view all the answers

    All of the following are hallmarks of RTC arthropathy, except:

    <p>increased acromio-humeral distance</p> Signup and view all the answers

    What is the neck-shaft angle range for Univers II and Apex?

    <p>125-140</p> Signup and view all the answers

    What is the goal of the screw in TSA?

    <p>to keep the humeral head centered on the glenoid</p> Signup and view all the answers

    All of the following are requirements for SCR except:

    <p>irreparable subscap tear</p> Signup and view all the answers

    Study Notes

    Humeral and Glenoid Anatomy

    • Humeral articular cartilage constitutes 1/3 of the humeral head sphere.
    • There is a constant ratio between the humeral head diameter and the height of the articular cartilage.
    • The anatomic neck is the approximate line for humeral head osteotomy.
    • Humeral retroversion occurs at approximately 30 degrees, divided into 10 degrees at the elbow and 20 degrees at the humeral head.

    Glenoid Morphology

    • Key morphological considerations of the glenoid include depth, version, inclination, and anatomical position relative to the scapula.
    • Arthritis can alter these four morphological features.
    • Walch Classification categorizes glenoid arthritic changes.

    Walch Classification Overview

    • Classification A indicates humeral heads centered in the glenoid.
    • A1 denotes no glenoid erosion with humeral head centered.
    • A2 involves a centered humeral head with significant glenoid erosion.
    • Classification B shows posterior subluxation of the humeral head.
    • B1 indicates narrowing of the glenohumeral joint due to posterior subluxation.
    • B2 features posterior glenoid erosion with retroversion leading to paleo-glenoid and neo-glenoid.
    • Classification C involves over 25 degrees of retroversion and dysplastic glenoid.

    Osteoarthritis (OA) Insights

    • The most common wear pattern in shoulder OA is posterior wear/retroversion.
    • Hallmarks of OA visible on X-rays include osteophytes, subchondral cysts, and joint space narrowing.

    Surgical Approaches and Techniques

    • The deltopectoral approach is the most common for total shoulder arthroplasty (TSA) and reverse TSA (RTSA).
    • Rotator cuff arthropathy features severe muscle atrophy, humeral head elevation, intact nerve conduction, and decreased acromio-humeral distance.

    Glenoid Polyethylene and Fixation

    • Glenoid poly material is UHMWPE with options for pegged, keeled, and vault lock designs for fixation.
    • Vault lock glenoid design promotes immediate fixation and reduces OR time while enhancing long-term survivorship through bony interdigitation.

    Implant Design and Features

    • Univers II and Apex systems allow inclination variability of 125-140 degrees and retroversion variability of ±10 degrees.
    • Distal dip diameter is critical when selecting TSA stem sizes.
    • Apex stems are designed for less post-operative pain and faster recovery by using shorter stems and similar geometry to standard models.

    Specific Functional Elements

    • Stability for glenoid poly is achieved through subchondral bone interactions, essential in TSA.
    • Screw angulation in proximal humeral fracture suture plates allows up to 60 degrees of variability.

    Clinical Guidelines and Indications

    • Requirements for superior capsular reconstruction (SCR) include large irreparable rotator cuff tears and a functional deltoid muscle.
    • CA heads are indicated for deltoid insufficiency instead of RTSA, highlighting the importance of muscle integrity in surgical planning.

    Storage and Preparation

    • AFLEX dermal allografts must be used promptly after being kept frozen, providing a thickness of 3.0 mm for specific techniques.

    Radiographic Evaluation

    • CT scans must be compressed before uploading to the VIP system, ensuring efficient data handling in surgical planning.### Humeral Canal Preparation
    • Preparation involves reaming to the appropriate size and implantation of the stem for the univers shoulder fracture system.

    Glenoid Targeted Coordinates

    • Turnaround time for receiving glenoid targeted coordinates after VIP plan approval is 48 hours.

    Adjustable Height in Arthrex Univers FX System

    • The adjustable height feature of the Arthrex univers FX system stem allows for a height adjustment of +/- 7.5mm.

    Wolff's Law

    • Wolff's Law indicates that changes in stress on a bone result in adaptations, suggesting bones remodel in response to the forces exerted on them.

    Candidate Selection for Percutaneous Pinning

    • A patient with a high likelihood for avascular necrosis (AVN) is not a good candidate for percutaneous pinning of a proximal humeral fracture.

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    Test your knowledge on key concepts related to the humeral head in Total Shoulder Arthroplasty (TSA) with these flashcards. Each card presents vital information on cartilage structure, ratios, and osteotomy lines that are essential for understanding shoulder anatomy and surgical procedures.

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