Shoulder Arthroplasty

426 Pages·1999·34.214 MB·English

by  R. Emery, M. Bankes (auth.), Gilles Walch M.D., Pascal Boileau M.D. (eds.)

Gilles Walch • Pascal Boileau (Eds.)
Shoulder Arthroplasty
Springer-V erlag Berlin Heidelberg GmbH
Gilles Walch • Pascal Boileau
(Eds.)
Shoulder
Arthroplasty
Foreword from Norbert Gschwend
and Richard J. Hawkins
With 348 Figures (70 in Colour)
and 63 Tables
• Springer
Gilles Walch, M.D.
Department of Orthopaedic Surgery
Clinique Emilie de Vialar - University of Lyon
116, Rue Antoine Charial
69003 Lyon, France
Pascal Boileau, M.D.
Department of Orthopaedic Surgery
Hopital de L'Archet - University of Nice
151, Route de Saint-Antoine de Ginestiere
06200 Nice, France
Library of Congress Cataloging-in-Publication Data
Shoulder Artbroplasty / G. Walch, P. Boileau (eds.)
lncludes bibliographical references and index.
ISBN 978-3-642-63554-0 ISBN 978-3-642-58365-0 (eBook)
DOI 10.1007/978-3-642-58365-0
1. Shoulder joint-Surgery. 2. Artificial shoulder joints.
I. Walch, G. (Gills), 1952 - . II. Boileau, P. (Pascal), 1956 - .
[DNLM: 1. Shoulder joint-Surgery. 2. joint Prosthesis-methods.
3. Arthroplasty-methods. WE 810 S558615 1999J
RD557.5.S543 1998
617.5'n0592-dc21
DNLM/DLC
for Library of Congress
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© Springer-Verlag Berlin Heidelberg 1999
Originally published by Springer-Verlag Berlin Heidelberg New York in 1999
Softcover reprint of the hardcover Ist edition 1999
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To my wife Nicole and my children Arnaud,
Matthieu, and Anne-Claire, who are the best
part of my life.
G. Walch
To Dominique, Marie and Pierre; they made
a dream come true, and to my parents for
understanding and support through all the
years.
P. Boileau
"Give me something different for there
is a chance it might be better."
E.A. Cadman, The Shoulder, 1934
"The tail is more important than the dog,
but we shall have to have the dog
to wag the tail!..."
Dr. Edward Martin, talking about
the "end result idea" ofCadman
Foreword
From Norbert Gschwend
Of all the medical specialities, orthopaedic surgery ofthe functional anatomy of the glenohumeral joint
has become one of the most coveted by the public as well as its relation to scapulo-thoracic motion.
and tremendous advancement has been made in the Based on their tremendous experience in the basic
last 20 years. To a great extent this can be attributed anatomy and its relation to function, they were
to the advent of artificial joint replacement. We are able to develop a prosthetic device which could
living in times in which many will enjoy a longer take into account individual anatomic variation in
life, but, unfortunately, this is also accompanied by each patient, making the successful outcome of sur
an increase of fear of sickness and invalidity. In gery much more predictable. Success in shoulder
such situations, those physicians who can offer a arthroplasty surgery is not necessarily dependent
remedy for pain, and at the same time increase only on the principle ofconstruction ofa prosthetic
the quality oflife, will be held in the highest regard device nor the way this devices is implanted or fixed
by their patients. It was Sir John Charnleywho, with to the bony interface, but more so by the under
the introduction ofbone cementand the low friction standing and handling of the soft tissues surround
principle of arthroplasty some 40 years ago, made ing the articulation.
the success of artificial joint replacement for the The book presented here by two outstanding
hip and later the knee joint possible. It then only young orthopaedic surgeons representing a new
became a question of time that other joints, such generation in the long tradition of French shoulder
as the ones of the upper extremity, could also be surgery not only informs the reader of the current
replaced. Charles Neer II introduced a shoulder state of the art in shoulder arthroplasty, but also
arthroplastysome 30 years ago for cases ofposttrau enlightens him with an understanding of what
matic destroyed shoulder joints. His technique advancements can be achieved with innovative
became successful and generally accepted when it thinking in this fascinating field of orthopaedic
was possible to replace the humeral head as well surgery.
as the glenoid surface despite poor bony conditions.
So it was not surprising that speciality centers deal
ing with multiple joint disease in rheumatoid Zurich, Professor Norbert Gschwend
patients were at the forefront in developing total Switzerland, (Founding Member
shoulder joint arthroplasty. August, 1998 of the European Shoulder
Pascal Boileau and Gilles Walch should be given and Elbow Society,
great credit for having furthered our understanding SECEe)
Foreword
From Richard J. Hawkins
It is indeed an honor and a pleasure to write a fore The book allows the authors to introduce their
word for this outstanding book on shoulder arthro concept of "prosthetic adaptability", based on care
plastybyourfriends Gilles Walchand PascalBoileau. ful analysis of proximal humeral anatomy. The
Itprovidesastate-of-the-artoverviewofbasicscience major advantage is humeral component design
research, including biomechanical design, to help us changes that allow the prosthesis to be matched to
better understand and manage the different patholo the patient's anatomy, rather than matching the
gies encountered requiring arthroplasty. Dr. Charles patient's anatomy to the prothesis. The adjustments
Neer, more than any other shoulder surgeon, has allow individual accommodation of the patient's
taught us that shoulder replacement is a highly suc inclination, retroversion, and offsets. The glenoid
cessful operation. It has evolved from constrained to component remains with a keel design, but the
Neer's system to modular components and, finally, authors very carefully describe the necessary tech
to humeral-glenoid mismatch, providing further nique for its insertion. The humeral prosthesis is
improvements in outcome. This book and the pro smooth and designed for cementing, something
posed design changes take us to another level of different for many North American surgeons who
shoulder arthroplasty. have found press-fitting to be successful. However,
Dr. Walch and Dr. Boileau are to be thanked for new design modification to allow press-fitting and
spear-heading and organizing a wonderful faculty other glenoid design options is ongoing.
to teach us about arthritis of the glenohumeral The inventors have enlisted their friends in a
joint, bringing this book to a reality. multi-center trial and now report their highly suc
This is the most advanced and up-to-date discus cessful outcomes. Arthritis and arthroplasty of the
sion on arthritis and arthroplasty in the literature. shoulder are growing in importance and deserve a
The book addresses biomechanics, design, and comprehensive text that addresses all the related
many pathologies from osteoarthritis to fractures issues. This book is a must-read for any shoulder
and massive cuff-tear arthropathy and includes surgeon and will surely find its wayonto our shelves
surgical indications and techniques. It discusses as a reference.
the intricacies of avoiding and managing the many
pitfalls that can occur during this challenging Vail, Colorado, Professor Richard J. Hawkins
surgery. August, 1998 (Founding Member and Former
President of the American
Shoulder and Elbow Surgeons)
Preface
This book is the result ofthree friendships: Thefirst the "adventure of shoulder arthroplasty". They
close friendship started in 1988, when the two of us agreed to share their knowledge and helped us to
met at the Orthopaedic Department of the Univer treat and rehabilitate our patients and finally to
sityofLyon, France. In our experiencewith shoulder evaluate the results ofboth operative and nonopera
arthroplasty we had both encountered consistent tive treatments.
difficulties in recreating the normal anatomy and In 1996 the time had come for us to analyze our
therefore we started working on the anatomy and results even though the follow-up was short. These
kinematics of the normal shoulder and prostheses. results have been reported in a Symposium on
We observed that the nonconstrained prostheses Shoulder Arthroplasty, held in Nice on June 27, 28,
used at this time (monobloc, first generation pros 29th 1996. This book consists, in part, ofthe manu
thesis) rarely reproduced the normal kinematics of scripts based on presentations from this meeting
the shoulder. Using our anatomical studies and and is the result of an intense and friendly colla
with the help of the engineers from Tornier, we boration of the entire "dream team"!
designed a new type of humeral implant: this pros The objective of this book is fourfold:
thesis was not only modular, to match the variations
• First, to expose the concept of prosthetic adapt
of dimension (second generation prosthesis), but
ability based on the basic research performed to
also adaptable, to respect the individual shape of
improve the understanding of the three-dimen
the proximal humerus of each patient. This third
sional geometry and kinematics of the shoulder.
generation prosthesis was called Aequalis, because
• Second, to present the early clinical and radiolo
our goal was to equal the anatomy and kinematics
gical results of more than 400 patients operated
of the normal shoulder. The first prostheses were
on with the Aequalis prosthesis and prospectively
inserted in 1991 by the two of us simultaneously
followed since 1991; all the failures and complica
in Lyon and in Nice. In the meantime, we tried to
tions as well as their management and the need
enhance the fixation of the glenoid component by
for revision surgery are reported in detail and
designing an uncemented glenoid using a system
are closely analyzed for the various etiologies.
of expanding screws and we developed instruments
• Third, to expose the improved understanding of
for the humeral component, the glenoid component
the various disease processes (osteoarthritis, rheu
and specific instruments for the fractures cases
matoid arthritis, avascular necrosis, arthritis with
(the Aequalis Fracture Jig).
massive cuff tear, acute. fractures and fractures
The second friendship started in 1992 when a
sequelae ) as well as their clinical and radiological
group of 15 European surgeons agreed to use the
presentation which was gained from the large
Aequalis prosthesis with prospective assessment
cohort of patients reviewed.
involving evaluation sheets and radiographs pre
• Fourth, to give any practical details that may help
and post-operatively. Although we had known
the surgeon and the physiotherapist that we found
many of those surgeons personally for a long time,
to be important for an optimum result in
we grew closer through the frequent contacts and
shoulder arthroplasty.
meetings needed to evaluate our results, creating
an "esprit de corps" where working and laughing It may be argued that a multicenter study and a
could be present at the same time. This group of short follow-up are useless for evaluating the results
early users was called the Aequalis Group and has ofprosthetic surgery. We disagree with this point of
been working enthusiastically and in close coopera view for many reasons. First, we would have failed
tion since that time. in our duty ifwe had not presented the early results
The third friendship is related to our close colla of a new implant, based on a completely different
borators,rheumatologists,physiotherapistsandradio concept. Secondly, the functional result for a pros
logists who have been working with us for many thesis is establishedwithin 1year. Thirdly, this series
years and who were willing to embark with us on represents a unique experience ofshoulder surgeons
XII Preface
using the same prosthesis, inserted in a standard our patients and to reevaluate carefully the results
manner, which would naturally diminish the influ in the near future. We believe that our studies have
ence of technological elements on the results. already helped us to improve the qualityofcare pro
Fourthly, the clinical results have been evaluated in vided to our patients.
a uniform manner in the different centers by using We did take a different way. We would like to
the Constant Score which has been recognized to point it to others because it looks promising!...
be objective and interobserver reliable. Finally,
these early results should serve as the foundation
for the addition of the knowledge of tomorrow; Gilles Walch and Lyon, Nice,
they will not prevent us from continuing to follow Pascal Boileau August, 1998