Name: Univers VaultLock® Glenoid System
Uploaded: 2017-03-08T00:00:00Z
Channel: Arthrex
Description: Patrick J. Denard, MD, (Medford, OR) demonstrates the Univers VaultLock ® Glenoid System technique. The Univers VaultLock Glenoid System represents a significant step forward in glenoid design – providing both enhanced fixation and bone conserving features.

<p>Patrick J. Denard, MD, (Medford, OR) demonstrates the Univers VaultLock<sup>®</sup> Glenoid System technique. The Univers VaultLock Glenoid System represents a significant step forward in glenoid design – providing both enhanced fixation and bone conserving features.</p>

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video

VID1-00941-EN | B | Univers VaultLock® Glenoid System

Patrick J. Denard

Human

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Surgical Technique Videos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Univers VaultLock® Glenoid System

So here we have a good exposure of the glenoid. We have our anterior aspect of our glenoid and posterior aspect superior and inferior. And we have a cannulated system. First we have a guide here. As you can see we're going to center it and and then insert our guide pin. This is a 2.8mm guide pin. Once the pin is inserted we remove the guide. And then we can ream over the top of that guide. And the way this reamer is designed is that it will enlarge as it goes in a circle, so that it can push the posterior retractors out of the way. In addition, the reamer is appropriately sized for each glenoid, and the reason for that is the radius of curvature of the reamer is going to match the back side radius of curvature of the glenoid, which is specific for each glenoid size. For our large glenoid, we have a flatter radius of curvature, and for our smaller glenoid we have a more curved radius of curvature to match the normal anatomy. So we're going to reme as minimal as possible just to scratch the surface. Once our reaming is complete, we need to establish the center hole. This reamer has a positive stop. The guide pin is then removed and then we can prep our glenoid. So we insert our glenoid prep guide next. And there's a superior hole which we're going to use to establish our role of the glenoid implant. Once that drill is inserted, we remove the drill and leave it in place. That's going to establish rotational control for us. So that preps the superior and the inferior peg. And now we need to prep the inferior keg or keel. We now need to prep the remaining portion of the keg in fairly, so we need to punch out the slot for the inferior aspect of the glenoid. There's our completed preparation. As you can see, we have an in-line preparation. The advantage here is that we have a pegged component. So we have the advantage of longevity of a pegged component. But we also have more of an in-line preparation which is going to avoid Peg perforation anteriorly and posteriorly. If we'd like we can insert a glenoid trial to assess our component seating. This is a semi radiolucent trial which allows us to check the component radius of curvature match to the glenoid. The VaultLock glenoid component is designed to achieve long term stability by having bony ingrowth, particularly with regard to the central peg. So you can see there are large fins there centrally, and our goal is to get bony interdigitation at that component. So we have several options for addressing that central component. One is to use no graft. Another is to use autogenous bone graft from the shoulder. And another is to use demineralized bone matrix. We're first going to demonstrate using a technique for humeral head bone graft, which is the most common source of graft that we use. Now there are two sources we can use for autogenous bone graft. One is to take remains from the glenoid preparation. You can see the reamers we use here have bone graft within the flutes. The most common source of bone graft that I use is to use bone graft from the humeral head itself. So what we've done here is we've preserved the humeral head that we resected. And now we're going to prep this as we would prep a glenoid. First we need to take a drill and create a pilot hole in the center aspect of the humeral head. And I'm holding the humeral head with a towel clip. Now that we've created a pilot hole, we're going to take the reamer from the standard glenoid set. This is a fully radiused reamer. We can then insert it into that pilot hole, and we're going to simply ream into the head in order to obtain bone graft. You can see here that we have a nice slurry. And this is going to apply nicely to the central peg of the VaultLock. So we have a graft compaction tool that's going to allow us to apply this bone graft to the central peg of the VaultLock. So we put this slurry inside of the graft compaction tool. And then we can simply clamp the central peg as such. And then we can rotate the glenoid component to compress the graft into the central peg. Then in terms of removal rather than opening, we want to pull the graft off to apply graft to the back of the glenoid component. Now typically this will apply graft to one side of the component but not necessarily get it to the other side. So we want to repeat this step. So again we're going to take our graft compaction tool. And now apply that graph to the opposite side and turn and pull it off. So here's our completed preparation where you can see we have circumferential bony opposition around the central peg. Now we're going to complete our insertion of the glenoid component. First we want to place cement peripherally. And we're going to place this both in the top and the bottom pegs. So we're going to place cement. And we're going to pressurize up to three times. Here we pressurize a third time. Now we're going to move to insertion of the final component. It. So here we can place cement on the bottom. We want to make sure that we get inside the keg in fairly. And then we can also place a light amount of cement around the top and the bottom fins. So we want to insert the glenoid component provisionally. And we want to make sure that our pegs are in line superiorly and inferiorly. And we do that by manual pressure. And then once we feel that we are aligned we then impact the glenoid component following impaction. We're going to use our freer here. And we're going to check peripherally for any cement extravasation and clean that if necessary. And then we're going to check that we have full seating of the glenoid component which you can see around here Circumferentially. We have full seating and excellent initial stability of the implant. Now an aspect of this glenoid component that is unique. Is it particularly with the impaction because of the inherent press fit design centrally, you do need to apply manual pressure to engage the central peg, and you are going to encounter slightly more resistance during impaction of the of the component, but that design has the advantage. Of course, of long term stability of the component. As an alternative to autogenous bone graft, one can use demineralized bone matrix and apply that around the central peg of the glenoid component. Here we have one cc of Demineralized bone matrix, and we can again use our graft compaction tool to apply this to the glenoid component. So we'll fill the jaw of the bone graft compaction tool and apply that to the central peg of the VaultLock. Similarly to how we applied this during the application of the bone graft. Again, you can see that we have one side primarily that's been filled. So we'll repeat the process so that we can complete the preparation. So we apply that twice to ensure that we have circumferential preparation of the VaultLock component. Here you can see the final preparation where we have circumferentially applied the putty around the central peg.

Univers VaultLock® Glenoid System

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