Complex and revision problems in shoulder surgery PDF
Preview Complex and revision problems in shoulder surgery
0491 fm(i-xviii).ps 1/12/05 2:34 PM Page i Complex and Revision Problems in Shoulder Surgery Second Edition 0491 fm(i-xviii).ps 1/12/05 2:34 PM Page ii 0491 fm(i-xviii).ps 1/12/05 2:34 PM Page iii Complex and Revision Problems in Shoulder Surgery Second Edition EDITORS JON J. P. WARNER, M.D. Chief, The Harvard Shoulder Service Professor of Orthopaedic Surgery Harvard Medical School Massachusetts General and Brigham and Women’s Hospitals Boston, Massachusetts JOSEPH P. IANNOTTI, M.D. Chairman, Department of Orthopaedic Surgery The Cleveland Clinic Cleveland, Ohio EVAN L. FLATOW, M.D. Lasker Professor of Orthopaedic Surgery Chief of Shoulder Surgery Mount Sinai Medical Center New York, New York 0491 fm(i-xviii).ps 1/12/05 2:34 PM Page iv Acquisitions Editor:Robert Hurley Developmental Editors:Joanne Bersin and Eileen Wolfberg Marketing Director:Sharon Zinner Project Manager:Fran Gunning Manufacturing Manager:Ben Rivera Production Services:Maryland Composition Printer:Quebecor-Kingsport Copyright © 2005 by Lippincott Williams & Wilkins 1st Edition Copyright © 1997 by Lippincott-Raven Publishers All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review. First Edition reprinted by Lippincott Williams & Wilkins 530 Walnut Street Philadelphia, PA 19106 USA LWW.com Library of Congress Cataloging-in-Publication Data Complex and revision problems in shoulder surgery / [edited by] Jon J.P. Warner, Joseph P. Iannotti, Evan L. Flatow.— 2nd ed. p. ; cm. Includes bibliographical references. ISBN 0-7817-4658-2 1. Shoulder—Surgery. 2. Shoulder—Surgery—Complications. 3. Shoulder—Reoperation. I. Warner, Jon J. P. II. Iannotti, Joseph P. III. Flatow, Evan L. [DNLM: 1. Shoulder—surgery. 2. Intraoperative Complications. 3. Surgical Procedures, Operative—methods. WE 810 C736 2005] RD557.5.C64 2005 617.5(cid:2)72059—dc22 2004029976 Printed in the United States of America ICP 10 9 8 7 6 5 4 3 0491 fm(i-xviii).ps 1/12/05 2:34 PM Page v Dedications To James H. Herndon, M.D., MBA, my mentor and friend. Who always said what he meant, meant what he said, and led by example. —JJPW To my son Matthew, whose inner strength through a verydifficult time in his lifewill always be my strength. —JPI To my wife and family, for their love and support. —ELF 0491 fm(i-xviii).ps 1/12/05 2:34 PM Page vi 0491 fm(i-xviii).ps 1/12/05 2:34 PM Page vii Introduction Three highly recognized and respected American editors troversial the more complex the subject of the individual have revised their indispensable text with the latest meth- chapter is. The senior authors of all chapters are in the ods on treating complex and revision problems of the prime of their professional careers and are undoubtedly the shoulder. Their effort is timely: the interest in shoulder leading international experts, representing a wide variety of surgery has grown considerably and, hence, the number of approaches. So, even if a reader should disagree with any interventions has increased. Problems of increasing com- methodologies in this text, it would be wise to remember plexity are being handled, and revisions have become more that there are “many streets that lead to Rome.” The shoul- frequent and more difficult. In addition, the methods of der surgeon should review the respective chapters in detail treatment have changed dramatically, resulting in enor- and incorporate the knowledge offered in this text into his mous progress made in surgical outcomes brought about or her judgment. In the field of complex shoulder prob- by the modern inverse prostheses, among many other new lems, it would be an error not to have consulted this essen- developments. tial reference book, for which the editors should be con- The subject is a difficult one by nature of its specializa- gratulated. tion: complex and revision problems are not commonplace operations, and, thus, are difficult to subject to evidence- Christian Gerber, MD based criteria. Rather than referring to large series in the lit- Professor and Chairman erature, the authors must base their approaches on per- Department of Orthopedics sonal experience and judgment; their texts, therefore, University of Zurich become by definition more worthwhile but also more con- Zurich, Switzerland 0491 fm(i-xviii).ps 1/12/05 2:34 PM Page viii 0491 fm(i-xviii).ps 1/12/05 2:34 PM Page ix Editors’ Introduction and Overview We are pleased to present the second edition of our book, an important emphasis is on decision making for selection Complex and Revision Problems in Shoulder Surgery. Since criteria for open surgery. For example, in the chapter by publication of the first edition, there has been an explosion Clavert, Millett, and Warner there is a clear description of of articles concerning management of problems affecting the degree of bone loss on the glenoid that requires an the shoulder, and numerous other books have been pub- open approach. Historically, this has been either ignored or lished as well. This intense interest has developed partly trivialized in the literature. There is also consideration due to the aging baby boomer population and its desire to given to management of capsular and tendon insufficiency remain active, performing overhead sports such as tennis, in the setting of failed anterior repairs. swimming, and golf. Shoulder injuries that may affect the The chapter by Miller and Flatow on Posterior and Mul- members of this demographic can occur through trauma or tidirectional Instability: Open Solutions nicely summarizes repetitive overuse, and threaten their quality of life. More all prior experience with these techniques and clearly illus- and more shoulder surgery is being performed and, unfor- trates the surgical approach to these problems. tunately, complications and the need for revision surgery Gerber’s consideration of Chronic, Locked Anterior and have grown exponentially. Posterior Dislocations is one of the only detailed accounts The use of shoulder arthroplasty, for instance, has in- of salvage and replacement of a severely damaged humeral creased at a rate of more than 15% per annum; currently, head in the setting of this rare condition. The chapter uses there is a global market in shoulder arthroplasty that ap- a number of clinical cases to illustrate the methods for op- proaches $200,000,000 annually. timal treatment. Many other textbooks on shoulder surgery have been Section II considers Rotator Cuff Tears. The chapter on An- written as extensive overviews of the problems that affect terior Superior Rotator Cuff Tears: Repairable and Irrepara- the shoulder. Our book is intended to be a different type of ble Tears, by Edwards, Walch, Nove-Josserand, and Gerber, publication. We have purposefully kept the book succinct considers problems that affect the subscapularis in combi- and focused on specific problems, and have attempted to nation with the supraspinatus tendon. The biceps tendon is organize these problems into logical sections. Each chapter also commonly involved and often overlooked, and is con- is contributed by author(s) who we believe are experts sidered in detail in this chapter as well. Clinical examina- based on their demonstrated surgical skill. We qualify this tion and radiographic imaging are documented exten- statement by further saying that these individuals have sively. Surgical treatment steps and outcomes are clearly been selected based on our opinion that we would permit presented, as are alternatives in the case of an irreparable them to perform the surgery they describe on us or our fam- tendon tear. ily members. This is the highest compliment one can pay The chapter on Massive Tears of the Posterosuperior Ro- another surgeon, namely that he or she is a surgeon’s sur- tator Cuff, by Higgins and Warner, presents a step-by-step geon. approach to open surgical repair of these injuries and illus- The three of us routinely encounter patients with failed trates details of latissimus tendon transfer in the case of an prior treatments and complex problems. We felt that the irreparable rotator cuff tear. Management of the unstable os book should be organized into clear, succinct, case-based acromiale is also described. presentations so that surgeons can cut to the chase, not Two chapters on Arthroscopic Rotator Cuff Repair are have to wade through extraneous information, and find ex- presented. The reason for this is to illustrate two experts’ ap- amples that may help them with similar cases. This, after proaches and their individual techniques. LaFosse, in his all, is the way we continue to learn from each other. Thus chapter, beautifully illustrates his surgical steps for arthro- experience becomes a shared benefit. scopic rotator cuff repair and reports his extensive experi- Section I deals with Shoulder Instability. In this edition of ence. Esch and Tucker’s chapter is somewhat different in its the book, we have included two chapters on Traumatic An- approach but no less elegant. The reader will be able to pick terior Instability and two on Multidirectional and Posterior and choose the methods that seem best for his or her skill Instability. In each case, experts in arthroscopic manage- and experience. ment explain their approaches and their success with their Section III considers Shoulder Stiffness. The chapter on Id- chosen technique. In the two chapters on open approaches, iopathic and Diabetic Stiff Shoulder by Cuomo, Flatow, 0491 fm(i-xviii).ps 1/12/05 2:34 PM Page x x Editors’ Introduction and Overview Schneider and Bishop describes the classification, pathol- treatment of these very challenging fractures and provides ogy, and epidemiology of frozen shoulder. These are very an instructive summarizing algorithm for treatment. important concepts to embrace as they are the basis for un- Scapular and Glenoid Fractures are considered in the derstanding the natural history of these conditions, which chapter by Getz, Deutsch, and Williams. This extensive is essential for selecting the most appropriate treatment op- contribution describes the epidemiology, anatomy and tions. The chapter on Acquired Shoulder Stiffness: Post- biomechanics of these problems as a basis for selection of traumatic and Postsurgical, by Holovacs and Warner, de- the best methods for treatment. Extensive drawings and scribes the variable pathology and the biomechanical case illustrations provide guidelines for surgeons who must consequences for shoulder function in patients with a stiff manage this kind of fracture. shoulder after trauma or surgery. Arthroscopic and open Acute Fractures, Malunions, and Nonunions of the Clav- treatments are illustrated with particular attention to icle are described in the chapter by Ring and Jupiter. The proper patient selection. authors’ extensive experience with these problems is illus- Section IV deals with Fractures of the Shoulder. This is the trated through numerous case examples that consider plate largest section of the book because we believe it represents and intramedullary fixation. one of the most difficult set of shoulder problems to man- Kwon and Iannotti in their chapter write about age. Acromioclavicular Joint: Difficult Problems and Revision Two-Part Proximal Humerus Fractures are considered by Surgery. The issue of superior-inferior instability is consid- Bishop and Flatow; surgical techniques such as closed re- ered, but particular attention is given to the clinical rele- duction and percutaneous pinning and open plate fixation vance of anterior-posterior instability and management of are illustrated in their contribution. Of special importance excessive distal clavicle resection. is the consideration of greater tuberosity fractures, which Finally, Wirth and Rockwood describe how they manage may be missed with dire functional consequences. Sternoclavicular Joint: Primary and Revision Reconstruc- Three-Part Fractures: Open Reduction and Internal Fixa- tion. A clear illustration of sternoclavicular reconstruction tion, or Arthroplasty, by Park, Stanwood and Bigliani, de- is provided through drawings and cases. scribes the advantages and methods of open reduction and Section V considers Shoulder Arthritis. Cameron and Ian- internal fixation, and also provides practical rules for de- notti describe Alternatives to Total Shoulder Arthroplasty ciding between open reduction and internal fixation and in their chapter, which leads off this section. The natural hemiarthroplasty for these difficult fracture configurations. history of the different forms of shoulder arthritis is pre- Aschauer and Resch write about Four-Part Proximal sented and options for arthroscopic debridement, os- Humerus Fractures; ORIF. While they clearly describe their teotomy, and interpositional arthroplasty are illustrated, thinking about why fixation is better than replacement in with results presented as well. some cases of four-part fractures, the description of closed Shoulder Arthroplasty in the Young, Active Patient, by reduction and minimally invasive osteosynthesis is very in- Lee, Flatow, and Warner, provide case presentations in formative. Indeed, Resch has been a pioneer in this revolu- which no other alternative but arthroplasty exists. The con- tionary approach to management of these complex frac- cept of anatomic reconstruction and modern surgical tech- tures, and he has shown that, with skill, the articular niques are emphasized as a basis for reconstructive tech- segment and its relationship to the tuberosities can be niques likely to yield a durable result in these “young” recreated anatomically while preserving vascularity and individuals. The controversy of hemiarthroplasty versus to- avoiding avascular necrosis in many cases. tal shoulder replacement is reconsidered in the context of The chapter on Four-Part Fractures: Arthroplasty, Preop- new available clinical and basic science data, and novel erative Planning and Surgical Management,by Warner and new techniques that offer promise, such as meniscal allo- Gerber, describes the authors’ approach to humeral head graft resurfacing of the glenoid and humeral resurfacing, replacement when salvage articular and tuberosity recon- are also illustrated. struction is not possible. The clearest and most helpful part Ian Kelley provides the benefit of a lifetime of experi- of this chapter is their description about preoperative plan- ence dealing with Special Issues in Inflammatory Arthritis ning, which includes practical guidelines for the surgeon, in his contribution. Rheumatoid arthritis and rotator cuff such as how to place the prosthesis at the correct height insufficiency are illustrated in detail. with proper humeral offset and version. Rotator Cuff Arthropathy: The Unconstrained Arthro- Bishop and Flatow describe their approach to plasty is described in the chapter by Safran and Iannotti. Ex- Nonunion of Proximal Humerus Fractures in the next perience with hemiarthroplasty is illustrated clearly. chapter. A variety of cases are used to illustrate the authors’ The Reverse Prosthesis chapter contributed by Sirveaux, best methods for fixation and for humeral head replace- Molé, and Boileau is a detailed presentation of a new tech- ment when reconstructing these fractures. nique now available to North American surgeons for the The chapter on Malunions of the Proximal Humerus, by treatment of difficult reconstructive problems where the ro- Ritzman and Iannotti, illustrates their best methods for tator cuff is no longer functional. This includes rotator cuff
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