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1. Αρθρίτιδα Ώμου
Νεότερα δεδομένα
Μάνος Αντωνογιαννάκης
Διευθυντής Κέντρου Αρθροσκόπησης & Χειρουργικής Ώμου
Διευθυντής Γ’ Ορθοπαιδικής Κλινικής Νοσοκομείου «ΥΓΕΙΑ»
www.shoulder.gr

2. • Most complex joint in the
body.
• One of the few joints with
360 degrees rotation.
• Extensive array of
ligaments and muscles.
Shoulder

3. The rotator cuff
anterior posterior

4. Causes of Shoulder Pain
• Osteoarthritis (wear and tear)
• Rheumatoid arthritis
• Rotator cuff tears
• Shoulder impingement (bursitis
and tendonitis)
• Repeated dislocations or fractures
• Trauma

5. Shoulder arthritis

6. Shoulder arthritis
• Healthy shoulder
joint
• Arthritic shoulder
joint

7. Shoulder arthritis

8. Symptoms and signs of
Shoulder Arthritis
• Pain:
• Reduced/Loss of range of motion
• Grinding or catching sensation
• Stiffness

9. Diagnosing Shoulder Arthritis
• Physical examination
• Medical history review
• Strength and Motion test
• X-Rays
• Magnetic Resonance Imaging (MRI)
• Blood tests
• Blood Count
• Rheumatoid Factor for rheumatoid arthritis
• C-Reactive Protein

10. Non-surgical Treatment Options
• medication
• analgesics
• NSAIDs
• Disease modifying med (R.A)
• Corticosteroids
• Τοπικές εγχύσεις
• Hyalouronic acid
• Biologic therapies (PRP stem cells)
• corticosteroids
• Activity modifications
• physiotherapy

11. Surgical Treatment Options
• Joint preserving surgery
Synovectomy
Arthroscopy
• Shoulder replacement surgery
• Hemiarthroplasty
• Total shoulder replacement
• Reverse shoulder replacement

12. Joint preserving surgery
Arthroscopic Synovectomy
• Early stages of inflammatory
arthritis.
• Removes inflamed tissue lining.
• Potentially saves joint from
further damage.
• Not a permanent solution

13. Joint preserving operation
Arthroscopy
• Used when osteoarthritis
causes small pieces of cartilage
to wear away from joint and
float around.
• Removes any debris and
smoothes cartilage surfaces.
• Thylacotomy

14. Shoulder replacement
when to consider;
• Experience significant pain.
• Reduced or loss of function despite
non-surgical treatments.
• Quality of life has significantly
changed.
• Medications for pain are no longer
effective.

15. Arthroplasty Options-resurfacing

16. Arthroplasty Options-resurfacing

17. Pre op

18. 7 months post-op

19. 7 years post-op

20. Resurfacing arthroplasty
• Initially reported very good results by
Copeland and Levy
• Younger patients
• Good bone stock-preserved humeral head
• Minimal surgery very attractive
But
• Technically demanding . Avoid overstuffing
the joint . Wear of the glenoid

21. Hemiarthroplasty
Total Shoulder
Reverse Total Shoulder
Arthroplasty Options

22. Arthroplasty Options
Anatomic
preserved-functioning rotator cuff

23. Arthroplasty Options
stemless
preserves bone stock –younger
patients

24. Arthroplasty Options

25. Patient positioning / c-Arm
Deltopectoral

26. Surgical Approach
Deltopectoral
Coracoid

27. Total shoulder replacement-
anatomic
functioning rot cuff
Depending on the damage,
the surgeon may replace:
– Only the humeral head
(hemiarthroplasty)
– Both the humeral head and
glenoid

28. Reverse shoulder arthroplasty
• Designed for end-stage cuff tear arthropathy sufferers
• Extreme shoulder degeneration; cannot function normally
• May improve motion and stability by changing shoulder mechanics
• Because the shoulder mechanics have been reversed, the stronger
muscles can now lift the arm.

29. Reverse shoulder arthroplasty
Recommended for patients:
• Age 70 years or older
• Experience significant pain
• Have little to no movement in their
shoulder
Not Recommended for patients:
• With bone disease, deficiencies in
the scapula or non-functioning
deltoid muscles
• Younger or physically active

30. Grammont reverse TSA
• The lever arm distance (L) is
increased and deltoid force (F)
is increased by lowering and
medializing the center of
rotation which is now also
fixed
• Torque (F x L) in abducting
the arm is increased.
Grammont Reverse Shoulder Arthroplasty - Biomechanics

31. Reverse TSA recruits more deltoid fibers
Ant. Pos.
Medializing the center of rotation
recruits more of the deltoid fibers
for elevation or abduction
Grammont Reverse Shoulder Arthroplasty - Biomechanics

32. Reverse shoulder arthroplasty
Potential Benefits to Patients
from Surgery
Return to mobility
Restore their lifestyle
Freedom

33. 7 months post op

34. Results after TSR
• 5 year implant survival
HA 89%
TSR 95%
Eichinger et al (2016)

35. Results after TSR
• 5years 94.2 %
• 10 years 90.2%
• 20years 81.4 %
Singh et al 2011
Mayo clinic

36. Results after TSR
• Shoulder arthroplasty in patients younger
than 50 years old
minimum 20years FU
75pt
TSR 83.2%
HA 75.6 %
Schoch et al (2015)
Mayo clinic

37. Total shoulder replacement both shoulders
4 years post op

38. TSR both shoulders
2,5 months post op

39. Μάνος Αντωνογιαννάκης
Διευθυντής Κέντρου Αρθροσκόπησης & Χειρουργικής Ώμου
Διευθυντής Γ’ Ορθοπαιδικής Κλινικής Νοσοκομείου «ΥΓΕΙΑ»
www.shoulder.gr
Ευχαριστώ!