Transcript Video BIO-RSA for A2 Glenoid Erosion [AP-014092A] In this video, Dr. George Athwal discusses BIO-RSA for A2 Glenoid Erosion. SKU: AP-014092A Hello. In the surgical video, I'll be presenting that technique for bio are safer management oven A to plateau erosion. As you can see in this x ray, there is substantial medial ization as a lateral aspect, the greater Travelocity's medial to the latter aspect, the chromium on the axillary. We can also see medial ization past the core COID base when looking at the parameters of this particular Glenarden is four degrees retro voted three degrees of superior inclination and approximately 66% subluxation. So let's go to the preoperative plan. So we're gonna template out of by our city. We could see that there is substantial osteo fights along the anterior aspect of Illinois. Let's go ahead and generate the graft. As you can see there, we still have the Austin fights and here and fairly, and we play the range of motion. We can see that those osteo bits are gonna impinge up against the polyethylene right where that red sphere is. So let's go ahead and virtually remove those osteo fights and replay the range motion. And so let's replay it. And now what we can see is that there's no longer that impingement against those osteo fights and we look at the range of motion. The abduction, abduction, intellectual rotation, extension, reflections all improved. So let's go ahead and make ah patient specific guide for this. The bone graft is gonna be five millimeters thick in fairly nine millimeters thick soup. Purely. And let's go to surgery. So I'm gonna make a Delta Pectoral decision approximately one centimeter lateral to the core. Coid. As you can see there, we'll go ahead and score the skin with a scalpel, and then I'll use the electric artery to work through layers. We'll get right into deltoid and use a GLP enteric. I'll go ahead and dissect approximately looking for Morn Heinz Triangle and the attachment of the deltoid onto the distal clavicle. Right there, there's more heads. Triangle something. I developed the most medial aspect the deltoid insertion, and developed a Delta picture animal in a proximal to distal direction. I typically take this a phallic vein immediately. We'll slowly tease our way through tissues, developed a Delta pectoral plane and work distantly. So there is the core Quaid See you ligament. There's the core coid, and this right here is the CIA ligament work through this aerial a tissue in the Delta Vector interval. There's a perforate er and work our way deep onto the condo intended all typically undermine the incision as I go distilling this is a small Richardson retractor we're gonna place directly onto the lateral aspect that the CIA ligament con joint tendon conductor lateral Sclavi Peck release all the way up to the inferior aspect of Seligman right there. Then go underneath the ceiling went into the sub criminal space. I like to use a small, blunt device to work underneath the ceiling into the sub chrome space to free up the adhesions and insert a brown a tractor. So once the deltoid retractors and identify the peck major right here, make a decision horizontally directly over to identify the long and biceps going through transverse ligament. And then I go ahead and release the biceps in a distal to proximal direction through the groove up into the rotator interval. Now I'm gonna go ahead and Kennedy's the long head of biceps to the peck major right here. We're going to secure that. And once I've conducted the teenage Jesus, I'm gonna go ahead and excise the long head of biceps proximal to the tune of Jesus developed a rotating enroll and tagged sub scapular errors. As you can see here, once I've tagged sub scapular is I'm gonna introduce a small dare a tractor into the rotator interval Place tension on subs captures and conduct a sub scapular peel approach peeling the entire sub scan if there was 10 and directly off the Leicester two Brasi and directing this into an inferior caps release working along the enter in fear and in fear portion of the human head. Now, this is a large terror track during a place into the joint to function as a skid to assist with dislocation. Now we've dislocated the human head a placement attractors to protect the so phallic. Here's the sclerotic here ahead bone which will harvest for the bio Karsa. So I'm gonna bring it a saw. Remove a thin wafer bone to have a nice flat surface to work with. Now, this is a 25 millimeter guide and this is a large reamer from a total level system. You can use any sort of barrel saw that would be just larger on the guide you choose. I'm gonna use a 25 millimeter diamond or base plate. And so I want a harvest bone graft That's just a little bit larger than that. As you can see there, I can fit the guide into the barrel. Rumor. So I know I'm gonna have approximately a 26 or 27 millimeter diameter bone graft. I'll go ahead and use the Glen oId drilled and sort of central drill hole within the human head. And over this, I'll bring in the barrel song. There is a commercially available system for this, and I'm gonna go ahead to a certain depth. And I selected a nine millimeter thick graphs. I'm gonna go into a depth of approximately a centimeter and so you can see is when we measure a depth of about a centimeters right to that first hole. So I know that's how deep I want to take that barrel saw. I'll go ahead to expand the central hole such like, um, place it over the extended post base plate. And now I'm gonna go ahead and cut out the graft bringing a saw to the entire super head neck junction. We'll bring this in and release the graft from the humorous. And here comes the graft. So go ahead and measure it. We preemptively plan for approximately nine millimeters thick, soupy, early and five millimeters thick and fearless. We'll be able Thio a perfectly shaped this graph to match the Glenroy. I'll go ahead and complete the an atomic head neck ost. Iata me. Typically, I'll make this at the patient's individual degree of retro version, So I'm gonna go ahead and prepare the Glenroy of bringing a large dare a tractor and place it post your inferior Early on the Glen wit, I'll add duct the arm and externally rotate is there. You can see a glimpse of the Glen oId go ahead and developed rotator vel removed the superior labor and the remnants of the biceps tendon and typically work poster superbly removing the labor creating space. And now I'm gonna place this medium sized era between the labrum and capsule. And to really see this hypertrophy labor, um, and the capsule and sub scapular errors is anti air superficial to the dare a tractor. I'll go ahead and remove all of this tissue now. No, go ahead and released the remnants of the capsule off the anterior portion of Lenin work and fairly and also released a portion of the long hair triceps along the inferior margin of clinical. Once you've got our releases done, a place for a tractor poster securely, I have my large dera post, your inferior Lee in a place, a double pronged, a tractor and here and fairly so there's are glad exposure. We can see this aid to deformity with medial ization. Here's our patient specific guide. I'm testing it on the middle surrogate and was unhappy with the position of Go ahead and place it on to the patient and you could see a keys in. Now I'll go ahead and search the guide pin through the proximal aspect of the guide. Well had removed the guy. Now we'll confirm that we're happy with the guide plane placement. You see this pace? The letter is very sclerotic. We'll go ahead and just do a light touch up dream because really, this is clitoris. Media lies enough where you need toe build in some liberalization of the bone graft just to give it a little bit of a touch up. In this particular case, the gill I know it is quite sclerotic, So I will perforate it in hopes to promote some bleeding and healing of the bone graft to the sclerotic limit. So work our way all the way around. Once I've done that, we'll go ahead and create our extended post drill hole in this case that my plan was to go buy a cortical and you could see, um, in the depth of glad for this approximately 20 millimeters. Then we'll go ahead and go to the last five millimeters, as this is a 25 millimeter drill. Now go ahead, assemble the graft and the implant inside table. So here we have our extended post. Basically, typically, I will always use extended post, basically with a bio. Karsa there will now insert the graft over the base plate. Like so that template this graphic nine millimeters thick soup purely in five militaristic in fairly saw. Go ahead and Roger the graph down, keeping it a little bit thicker than a template it to allow the bone to compress. So what about six or seven millimeters in fairly and about 11 millimeters thick soup early, It will be able to compress this down, so I'll place the graft s centric, Lee, as was preemptively template ID. They will impact that down. Used to graft just slightly larger than base plate, with the right medical commercially available by hours, a system the graft is line to line still will go ahead and secure the base plate. I typically place my inferior locking through first. Then my superior lock is group. Then my anterior poster compression spears and a drill all four at the same time. Once drilled, will insert the in fear locks. True, but not fully locking into the base plate. I'll do the same with Superior Screw. Then I'll go ahead and place my and your post. Your compression stirs secure those compress the graft between the bass playing host bone and now fix my locking screws down. Once we're done, we have a secure construct. Now, if you recall on the profit plan, we had anti Rasta fights. So once I paced placed in my base plate, I'll go ahead and remove those anti Rasta fights to maximize my interpretation and my abduction. So I spent some time removing those Oscar fights, and there you can see photograph. There's the Austin Fights that have been removed now go ahead and put on our Glenister a lever it into place and once into place will impacted and tighten. The securities group typically do this a couple times the shirts well seated and secured. Stella, go move on to the humerus will place in the medium dera along the Calle car to carefully take out the proximal humerus from behind the Glennis Fear. And there we can see or human had osteo to me, plays a sponge on the kacar. Now go ahead and start approaching and comp acting. So we'll start with the size one and worked our way up. I'll keep on progressing up in size with the compact er until I'm happy with the stability. My stability tests a gentle twist off the compact er to ensure it stable. Once I have a stable compact or I'll remove the compact or handle there, you can see the compact er. Now, if there's any prominent bone at the level of the osteo Tomy, I'll use this Cal car. Reamer. No, go ahead and Sirte the tree, and typically I'll place this with the six oclock position laterally to our medial ization of the human component. Now here we have our standard plus six polyethylene, and we'll go ahead and do a trial reduction. Bring the deltoid around the front and go ahead and reduce the shoulder. I'll typically give it a small, little inferior tug to ensure that there is a small gap that occurs at the articulation moving through a range of motion. And if I'm happy, we'll go ahead and dis articulate and start to assemble the true implants. Is this to remove our trial now before inserting my true implant? I'm gonna go ahead and prepare for Trans Odysseus repair off the subs calculators. So I typically use three number five Esteban suitors that I place around the stem of the implant. I start laterally and in fear Lee of the last two Rosty and go out immediately. He was stitched number two. I like to use a Kateri to burn my way through bone. No place this one slightly more medial on the Western generosity. It is a third and last ditch along the superior aspect of lesser generosity. I typically past the needles lateral to medial, and I keep the needle attached to the medial aspect of the future and with the needle still attached immediately. Once I produce and placed in the true implant probably used the same needle to secure the sub scapular errors. So will ensure that the stem of the implant goes through these futures. So we're ready for implantation. A side table. Here's our stem and then I'll go ahead and uncertain the flex tree six o'clock towards a superior aspect of the implant. I'll engage the Morris Taper and here's our polyethylene. So we're gonna make 145 degree head neck angle as we have e centric polyethylene. Well, there's her implant, all typically seated partially in and secure the suitors, wrapping them around the stem of the implant. Here we go. That will impact the implant in appropriately seated there. We have our final construct, and we're prepared for reduction. So go ahead and bring the deltoid, Sweep it anterior and reduce the shoulder. You go ahead, assessor stability, intention, and sure, there's no impingement, and then I'll go ahead and repair the subs. Kapler's all typically repair the subs. Kapler's whenever possible. So as you can see, I left the needles on to that medial aspect of the future. So go ahead and pass with suitors through subs, calculators. Then what's past? We'll go ahead and repair the subs. Kapler's and there we have our sub stamped letters repair that once repaired, I typically place 1 g of bank and wise and powder within the are throttling. They will go ahead and close adult a picture of it. So I typically is the number one Vicryl future to re approximate adults back Colonel to a Vicryl and Staples. And here are postoperative extras. A post operative day one with our bone graft in place. Thank you. Published October 29, 2020 Created by Related Presenters George Athwal, MD Orthopaedic SurgeonRoth | McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care View full profile
