Lima stemless reverse shoulder replacement surgical technique
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Learn the Lima stemless reverse shoulder replacement surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Lima stemless reverse shoulder replacement surgical procedure.
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.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
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- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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