Today, at the American Academy of Orthopaedic Surgeons (AAOS) 2021 annual meeting, Hospital for Special Surgery (HSS) sports activities medicine surgeon David M. Dines, MD, participated in an instructional case lecture on practical options in shoulder arthroplasty for patients with substantial shoulder socket bone loss often known as the glenoid bone deficiency. The interactive session supplied attendees with an attractive alternative to learn about the latest imaging and diagnostic methods, presurgical planning tools as well as arthroscopic techniques and implants, together with patient-specific, convertible implants.
The glenoid is the socket a part of the shoulder joint that connects to the ball of the higher arm bone. Glenoid bone loss can occur because of severe arthritis, traumatic harm, or repetitive overuse in sports activities like baseball or swimming. It can also happen because of failed earlier surgery. Signs related to glenoid bone loss embody irritation, pain, and decreased shoulder function.
During the session, eight circumstances of various levels of glenoid bone deficiency were introduced for consideration by session attendees divided into groups at dialogue tables. Members of an international panel of main shoulder surgeons from the US, France, and Italy guided discussions at every desk as contributors formulated potential surgical approaches for every case. After groups shared their proposed approaches in a round-robin format, it was introduced how HSS treated the circumstances. Attendees then had the possibility to debate and critique the options.
Session participants were informed concerning the newest improvements for addressing glenoid bone loss, starting with superior diagnostic imaging and pre-op planning systems used at HSS, one of many establishments with this functionality.
Surgical approaches introduced included two bone grafting techniques: bony increased offset-total shoulder arthroplasty (BIO-TSA) and bony increased offset-reverse shoulder arthroplasty (BIO-RSA). The latter reverses the ball and socket components of the joint for increased stability. Another case illustrated an augmented glenoid implant, which makes use of a metal or polyethylene wedge or a bigger steel plate to interchange bone loss. HSS has been at the forefront of creating augmented glenoid implants, Dr. Dines said.
Three complicated circumstances of serious bone loss highlighted using patient-specific implants, the newest innovation within the subject pioneered at HSS by Dr. Dines and colleagues. Known as the glenoid vault reconstruction system (VRS), it’s used for patients with significant loss of bone and supporting joint structure. “We create a customized implant for every affected person, based on 2D and 3D CT scans,” he defined. “The VRS works nicely to deal with severe bone loss in patients with advanced rheumatoid arthritis, after tumor removal or for revisions.” Dr. Dines said he looks forward to presenting outcomes on treating about 75 HSS patients with the VRS at next year’s AAOS annual assembly.
“It is a thrilling time for advances in shoulder arthroplasty,” he concluded. “Our interactive session sparked many fruitful discussions that I hope will result in increased shared studying and the event of extra improvements for enhancing affected person outcomes.”