Allograft-Prosthesis Composite Reconstruction of the Proximal Part of the Humerus by Ayesha Abdeen, and John H. Healey JBJS Essent Surg Tech Volume os-92(Supplement.

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Presentation transcript:

Allograft-Prosthesis Composite Reconstruction of the Proximal Part of the Humerus by Ayesha Abdeen, and John H. Healey JBJS Essent Surg Tech Volume os-92(Supplement 1 Part 2): September 1, 2010 ©2010 by The Journal of Bone and Joint Surgery, Inc.

A fresh-frozen osteoarticular graft: a = articular cartilage of humeral head, b = humeral shaft, c = anterior capsule of shoulder joint, d = subscapularis tendon, e = supraspinatus tendon, f = deltoid insertion, g = pectoralis major tendon, and h = latissim... Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

The humeral head is osteotomized at the edge of the articular cartilage. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

The custom-made stem. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

The canal finder is inserted laterally. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

The distal part of the host humerus is reamed in a line-to-line fashion. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

The porous stem of the implant is covered with a latex-rubber digit cut from a surgical glove to shield the porous surface as the stem is inserted through the allograft filled with wet cement. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

The implant is impacted in 35° to 40° of retroversion with respect to the forearm. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

The shoulder is reduced and the soft tissues are repaired. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

Soft-tissue reconstruction consists of suturing the host capsule to that of the allograft in a vest- over-pants fashion. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

The remaining host deltoid tendon is often repaired to the remnant deltoid tendon of the allograft. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph showing the humerus and shoulder during postoperative internal rotation. Ayesha Abdeen, and John H. Healey J Bone Joint Surg Am 2010;os-92: ©2010 by The Journal of Bone and Joint Surgery, Inc.