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Surgical Technique

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Summary of Contents for Delta Xtend

Page 1: ...Surgical Technique This publication is not intended for distribution in the USA Powered by Xperience...

Page 2: ...ming guide positioning 1 Approach 2 Humeral head resection Modular Implant Cementless Technique Monobloc Implant Cemented Technique 1 Approach Delto pectoral Approach 2 Humeral head resection 1 Choice...

Page 3: ...eccentricity 5 Proximal humeral reaming 6 Diaphyseal broaching and angulation measurements 7 Epiphysis diaphysis assembly 8 Final implant insertion 9 Cup impaction Standard Option Eccentric Option 4...

Page 4: ...4...

Page 5: ...to avoid pull out torque on the glenoid component 3 4 Non anatomic neck shaft angle 155 for joint stability 3 4 Optimal Deltoid tensioning to maximise muscle action without over stretching the tissue...

Page 6: ...Drilling the Central Hole 23 Metaglene Implantation 24 Inferior and Superior Metaglene Screw Placement 25 Anterior and Posterior Metaglene Screw Placement 28 Placement of the Proximal Humeral Reaming...

Page 7: ...Humeral Implants Definitive Humeral Implant Insertion 44 Cemented Monobloc Humeral Implants Definitive Humeral Implant Insertion 46 Cases of Proximal Humeral Bone Loss 48 Revision to Hemi Arthroplast...

Page 8: ...ncreased internal rotation13 5 155 neck shaft angle for optimal joint stability3 6 Reduced diameter for bone preservation DELTA XTEND Reverse Shoulder System Features The DELTA XTEND Reverse Shoulder...

Page 9: ...ar surface for articulation against acromion Glenoid Component 13 Increased glenosphere diameter 38 and 42 mm and eccentric option for improved stability maximised range of motion and reduced risk of...

Page 10: ...placed within glenoid bone Pre operative planning should also be carried out using AP and lateral shoulder radiographs of known magnification and the available template to help the surgeon determine t...

Page 11: ...XTEND Reverse Shoulder System prosthesis can be implanted using a superior lateral deltoid split approach or a delto pectoral approach The choice depends on the surgeon s preference and clinical para...

Page 12: ...al subdeltoid and subcoracoid Palpate the axillary nerve at the anterior inferior border of the subscapularis muscle Figure 10 Electrocoagulate or ligate the anterior humeral circumflex vessels three...

Page 13: ...rk on the reamer is level with the pilot hole When using the long stem prosthesis pass the entire length of the cutting flutes down the intramedullary canal Sequentially ream increasing the diameter u...

Page 14: ...cal approach used superior lateral or delto pectoral Assemble the cutting plate on the cutting guide first 1 and then fix the cutting guide onto the cutting guide handle 2 Figure 14 The cutting guide...

Page 15: ...lly internal rotation However care should be taken not to damage the subscapularis insertion by resecting the head with excessive anteversion The cutting handle should then be rotated to align the ori...

Page 16: ...e to the humerus Figure 17 Following the colour code guidance the surgeon should resect 1 2 mm of the proximal area of the greater tuberosity at the level of the supraspinatus insertion in an intact s...

Page 17: ...bles the cutting plate to be reversed before being secured with the third divergent fixation pin providing a flat cutting surface Figure 18 Option 2 Place the humeral resection protecting plate onto t...

Page 18: ...infraglenoid tubercle Bluntly finger or elevator dissect in a circumferential manner from the base of the coracoid process to well beyond the most inferior aspect of the glenoid It is essential to pa...

Page 19: ...er to limit potential bone impingement while keeping a secure glenoid implant fixation However radiographic CT images combined with X ray templates and the intra operative view may indicate a slightly...

Page 20: ...d into the positioner handle Figure 22 Positioning the Metaglene Then insert the hex head tip of the handle into the corresponding plate hole right or left depending on the shoulder being operated upo...

Page 21: ...that the proximal handle of the instrument is not tilted superiorly The guide pin should be inserted either perpendicularly to the glenoid face or with a slight superior direction This ensures that t...

Page 22: ...engaging the glenoid It is useful to collect the bony products of reaming for possible grafting Irrigate frequently to maximise visualisation and thereby ensure optimal reaming Preserve the subchondra...

Page 23: ...ce No space should be seen between the instrument and the glenoid surface unless this is due to bone erosion Figure 30 Remove the resurfacing reamer leaving the metaglene central guide pin in place Fi...

Page 24: ...fill any surface irregularities between the metaglene and the glenoid bone Identify the rotational orientation that enables the inferior screw to be contained within the inferior pillar of the scapul...

Page 25: ...Hold the 2 5 mm drill guide against the inferior metaglene hole The drill guide can be angled to 10 but should always be seated fully on the metaglene hole Palpate the bony pillar and direct into goo...

Page 26: ...ge can also be used to obtain optimal screw length Insert the 1 2 mm guide pin through the drill guide and then remove the drill guide Figure 38 Slide the locking screw of the appropriate length onto...

Page 27: ...crew guide pin using the pin extractor making sure that the internal locking screw stays in place Repeat the same process to put the superior locking screw in place Drill the hole for the superior loc...

Page 28: ...4 Use the 2 5 drill bit with the drill guide to set the most appropriate angle for ensuring that each screw is located in good bone stock Figure 45 The preferred position is usually chosen by palpatin...

Page 29: ...n proceed with locking the polyaxial screws Place the locking screwdriver main body in place on the inferior screw head Make sure that the screwdriver sleeve is in its upper position and not in contac...

Page 30: ...Push the holder horseshoe plate fully down Figure 51 Slide the proximal reaming guide down into the intramedullary canal rotating it if necessary to ensure that the horseshoe plate sits flat on the bo...

Page 31: ...ion surface switch the centred proximal modular reamer adaptor for the eccentric adaptor in size 1 green Be careful to position the eccentric adaptor so that the eccentricity is posterior and not ante...

Page 32: ...er reaming should always be carried out carefully grasping the power tool handle with a sensitive and flexible hand grip Complete reaming has been achieved when the external reamer flange is in full a...

Page 33: ...th the anterior aspect of the bicipital groove This will ensure good distal stem orientation anatomic version for an optimised press fit Figure 59 Drive the broach down carefully to avoid any cortical...

Page 34: ...1 This angulation corresponds to the difference between the version of the stem close to anatomical retroversion 20 to 30 and the epiphysis version for a reverse shoulder close to 0 retroversion No ca...

Page 35: ...e The pin should be placed in the same retroversion position used to position the cutting guide i e close to 0 retroversion The orientation pin should then be aligned with the forearm axis and the tri...

Page 36: ...e final decision taken epiphysis size 1 or 2 This will determine reamer and final implant sizes Remove the sizer disk Select the appropriate proximal reamer for the monobloc implant size 1 yellow hand...

Page 37: ...in placed in the implant driver handle The pin should be placed in the same retroversion position used to position the cutting guide i e close to 0 retroversion The orientation pin should then be alig...

Page 38: ...commended to avoid scapular pillar conflict Figure 70 Depending on the glenoid pillar shape this overlap can be achieved using the standard glenosphere just by lowering the metaglene If the size of th...

Page 39: ...the scapula pillar inferiorly The arrow indicates the position of the eccentricity and should be positioned postero inferiorly aligned with the mid line of the scapular pillar Cup Trials and Trial Re...

Page 40: ...maximum forward elevation Assess stability at 90 abduction with the humerus in neutral maximum internal and maximum external rotation Estimate also the maximum forward elevation 18 Joint Tensioning a...

Page 41: ...o check that there is no soft tissue between the metaglene and glenosphere When accurate thread engagement is obtained and after a few turns remove the guide pin to avoid stripping in the screwdriver...

Page 42: ...crewdriver until the glenoid bearing closes on the taper of the metaglene Figure 77 Remove the guide pin Definitive Glenosphere Fixation Eccentric Glenosphere Obtain further impaction of the junction...

Page 43: ...can be disassembled by unscrewing the glenosphere central screw using the 3 5 hex head screwdriver yellow handle Figure 79 This option is possible due to the design of a specific internal screw syste...

Page 44: ...tem using the 3 5 mm hex screwdriver yellow handle and the special locking wrench for modular implants size 10 12 or 14 16 Figure 81 Both components should then be mounted on the humeral implant drive...

Page 45: ...lant driver handle Figure 84 Note the final modular humeral implants are larger by 0 5 mm than the trial implants to ensure an optimal press fit Impact the final humeral cup using the cup impactor Fig...

Page 46: ...w Some surgeons may wish to insert a one inch gauze pre soaked in an epinephrine 1 1 000 000 solution or hydrogen peroxide solution to aid haemostasis and the drying of the humeral canal Figure 87 Cem...

Page 47: ...Irrigate the wound thoroughly Place the trial articular surface and reduce the joint Confirm stability and dislocate the humerus Final cup fixation After thorough cleaning impact the final humeral cup...

Page 48: ...position Tighten the fin clamp on the humeral shaft first using the 3 5 mm screwdriver yellow handle 1 Figure 91 Note that aligning the retroversion guide pin with the forearm places the implant in 3...

Page 49: ...t Select the appropriate mark then place the trial stem beside the final implant and mark off the corresponding height on the implant Figure 93 Use this mark to cement the stems at the proper height S...

Page 50: ...lenoid loosening or when glenoid bone stock is insufficient to fix a metaglene securely the reverse shoulder can be converted to an hemi prosthesis as a salvage procedure Specific hemi heads with incr...

Page 51: ...venth week active strengthening movements may gradually be added to the programme These exercises which closely follow everyday activities are to be performed in a sitting or standing position using c...

Page 52: ...Eccentric Epiphysis Size 1 Left HA Coated 1307 20 103 Cementless Modular Eccentric Epiphysis Size 1 Right HA Coated 1307 20 201 Cementless Modular Centred Epiphysis Size 2 HA Coated 1307 20 202 Cemen...

Page 53: ...ter 4 5 mm Length 42 mm 1307 90 048 Locking Metaglene Screw Diameter 4 5 mm Length 48 mm Revision Implant Codes Cemented Monobloc Humeral Implants Long 1307 08 110 Cemented Monobloc Humeral Implant Ep...

Page 54: ...4 mm 5 2307 70 016 Handle for Cutting Guide 16 mm 6 2307 72 003 Delto pectoral Cutting Guide 7 2307 72 004 Delto pectoral Cutting Plate 8 2307 73 003 Superior lateral Cutting Guide 9 2307 73 004 Super...

Page 55: ...ular Eccentric Trial Epiphysis Size 1 Left 8 2307 20 101 Modular Centred Trial Epiphysis Size 1 9 2307 20 103 Modular Eccentric Trial Epiphysis Size 1 Right 10 2307 20 202 Modular Eccentric Trial Epip...

Page 56: ...Eccentric Glenosphere Trial 38 mm 10 2307 60 138 Standard Glenosphere Trial 38 mm 11 2307 99 002 Extraction T handle 12 2307 60 042 Eccentric Glenosphere Trial 42 mm 13 2307 60 142 Standard Glenospher...

Page 57: ...piphysis Size 1 10 mm Long 3 2307 12 110 Monobloc Humeral Trial Epiphysis Size 1 12 mm Long 4 2307 14 110 Monobloc Humeral Trial Epiphysis Size 1 14 mm Long 5 2307 10 210 Monobloc Humeral Trial Epiphy...

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Page 60: ...Reverse DELTA III prosthesis J Shoulder Elbow Surg 2005 14 5 524 528 9 De Wilde L Poncet D Middernacht B and Ekelund A Prosthetic overhang is the most effective way to prevent scapular conflict in a r...

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