Lima stemless reverse shoulder replacement surgical technique
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Reverse geometry configuration total shoulder replacements are in widespread use for the treatment of patients with rotator cuff deficient shoulders but particularly for those with arthritic change so called ‘cuff tear arthropathy’. Such implants have also been used in the management of patients with unreconstructable proximal humeral fractures, a technique which has been described on Orthoracle at https://www.orthoracle.com/library/lima-smr-reverse-total-shoulder-replacement-for-proximal-humeral-fracture/
The design rationale in replacing a prosthetic ball on the glenoid (the glenosphere) and a socket on the humeral side in a semi-constrained construct, medialises the centre of rotation and increases the moment arm on which the large deltoid muscle can work, in the absence of the rotator cuff tendons which normally insert around the proximal humerus.
Many Orthopaedic companies have developed such shoulder replacement implants. In this case, I am using the stemless humeral implant on the reverse geometry system from the Italian company Lima. The stemless humeral component is constructed on a 3D printer to create a single piece of trabecular titanium. Hip surgeons have used the same trabecular titanium for successful reconstruction of the hip acetabulum with impressive bony ingrowth of the implant. In the shoulder, if the patient’s proximal humeral metaphyseal bone is not too soft then impaction of the trabacular titanium core humeral implant gives excellent primary fixation and promotes future bone ingrowth securing the platform component. This is a bone preserving procedure avoiding the need to use an intramedullary stem. The same humeral core component is used for anatomical total shoulder replacement and this facilitates revision of an anatomic replacement to reverse one. It is very straightforward to switch the articulating components leaving the glenoid baseplate and humeral core implants, which should be solidly fixed to bone, in place.
The patient in this case is an 80 year old female who presented with pain and dysfunction in her non dominant shoulder. Clinical assessment and investigations revealed the diagnosis of glenohumeral osteoarthritis with a thin and weak rotator cuff. She had exhausted conservative measures and felt that her shoulder was bad enough to consider major arthroplasty surgery.
Author: Mr Mark Crowther FRCS Tr & Orth.
Institution: The Avon Orthopaedic centre, Southmead Hospital, Bristol, UK.