Name: Total Shoulder Replacement Using Eclipse™ Total Shoulder Arthroplasty System
Uploaded: 2019-09-24T00:00:00Z
Channel: Arthrex
Description: Anthony A. Romeo, MD (Chicago, IL), discusses the features and benefits of the Eclipse™ total shoulder arthroplasty system, which he uses to perform surgery for primary osteoarthritis.

<p>Anthony A. Romeo, MD (Chicago, IL), discusses the features and benefits of the Eclipse™ total shoulder arthroplasty system, which he uses to perform surgery for primary osteoarthritis.</p>

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VID1-000615-en-US | B | Total Shoulder Replacement Using Eclipse™ Total Shoulder Arthroplasty System

Anthony A. Romeo

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

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Total Shoulder Replacement Using Eclipse™ Total Shoulder Arthroplasty System

So in summary, it's a 64 year old gentleman with osteoarthritis. He's got the typical findings of a narrow joint space, large, inferior osteophyte, multiple loose bodies. And so he needs a total shoulder replacement. That's the gold standard. And our goal is to put a humeral head in the place that's anatomic for him and to get it to stay there. Traditionally that's required to stem anywhere from 12 to 15cm or longer. There are now a number of new stems that are shorter than that that are working very well. But for him we're going to use a stemless device, the Arthrex Eclipse. And this is a device that uses a trunnion that sits very nicely on our cut surface. And then a cage screw that fixes that trunnion in place. And then the humeral head of the appropriate size goes directly over the top of this. We really think this is going to be a great advancement in terms of the care of our patients with osteoarthritis. And we think that's for a number of reasons. One, it is a little simpler for all of us to do, which should make it that we're more consistent with it. We remove less bone. So it's a bone sparing operation, and we already know from our European colleagues for over a decade of experience. That's a very effective device. As we know, the keys to an anatomic shoulder arthroplasty is to pick out the correct humeral head size and then put it in the right spot. So what we're going to demonstrate now is the Eclipse shoulder arthroplasty system, which allows us to put a humeral head without a stem and keep it in the right spot. And this will be a nice demonstration of how this implant can work very effectively, minimize the amount of bone resection and stabilize the humeral head in the proper anatomic position. Typically, we'll operate on those patients early in the morning, and we can get them out by the evening time skin incision is made. He's an active individual so there's not as much fat. So we're just trying to free up our cephalic vein here. Continue on down. And you can see we have a pretty good size inferior Osteophyte, which again, we anticipated from our preoperative use that we're going to have to deal with this. It goes down quite a ways. In fact, he has quite a few loose bodies in his subscapularis recess, too. So we'll get to those later. And then we're going to take the Fukuda retractor and work across the glenohumeral joint and do our anterior capsule release, and then we'll come back to our humerus. So we'll take the humerus and we'll internally rotate. So now let's go back to our humeral side. We've got our release done on the humeral side and the glenoid side. And we're going to go back to take care of our humeral preparation. We'll take our large Darrah. We'll move our arm holder out of position. We'll put our Darrah across our glenohumeral joint, and then we'll dislocate the humerus from the glenoid. So we just want to look at the top here and see what we have in terms of the osteophyte. And just make sure that we have a nice understanding of where his anatomic neck is up here, even around the Around the rotator cuff. So we can see that. Well, and then we'll proceed on inferiorly. And trying to keep that plane right along the anatomic neck there. Oftentimes with these osteophytes you can come underneath them. And what you want to see is that little synovial fold. And that marks the normal plane of the cortical bone of the humerus. So that gets our bone off of the humerus. And now we have to go back to doing our humeral head cut. And we'll put this across the glenohumeral joint to dislocate the humerus. We'll now take a pointed medium sized home in. And we have a couple of options with regards to resecting our humeral head. One. The easiest one and one that we frequently do is just a freehanded head cut. So we can look at the rotator cuff and identify where the top of the rotator cuff is at, and mark that position. We can then look at the normal position of the articular surface, and then see that Inferiorly and get a pretty good idea of what we need to do to make the cut. To resect the articular surface. There are a number of guides available that can be helpful, such as this one. So if you're confused about the cut, you can put a guide pin down the humeral canal and use this to help you identify where you think the proper inclination is. This is at the mean of normal human inclination, which is between a 125 and a 140, or one 32.5. And again, you can also just put this up here and look at it and say, oh yeah, that looks pretty good. That's where I want to be. And we're in good shape with that. So now we're going to go ahead and use our saw to make our cut. [00:04:56] And. What we're going to do. Is just identify exactly where his articular surface should be. So this is more of his osteophyte still up front. You can see with that thick white line. And we'll just take that off so we don't overestimate the proper size. So on the Eclipse system, the sizes are all an odd number. So 49, 51, 53. So we'll go ahead and see what the 49 looks like. It's probably a little bit bigger than that, but we just want to check that out and we'll put that into position. And it actually looks really nice. Let's just see what one size smaller looks and see what the 47. You don't have to put it on the handle. Let's just take a look and see how that looks here. I think that one looks best. So we're going to do the 47. We'll tap in so we can see that up there. We'll tap in our little we'll tap in the pegs with a hammer. Once we have the the actual trunnion guide in position we'll then take our handheld reamer and prepare the bone. And then we'll take our center drill guide. And then we'll take our guide pin, which will help to identify the depth of the screw that we'll be using. So we'll slide in until we touch the opposite cortex. So small medium. And it's just short of the large. So we're going to use the medium. And then we can take out our center drill guide. We can lift up our trunion guide with an elevator. And then we can put our head cut Protector in position. Okay. That looks great. So now we'll go. And that's all the preparation we need to do for the humeral side. And we'll take out our head cut. Protector. We have to make sure this goes down nice and comfortably. So we don't want to push this too hard, but we got to get it back down to where it was at. So that looks very good. It looks like it's seated well. We want to identify the front and the back. Make sure we're seeing everything really well. Our trunnion will sit right over the center guide. And as you can see it's got a bone in growth. And on growth the surface, that's bone it. It's got the fins in place here to prevent rotation and give it some primary stability as it goes into position. And what we'd really like to see when this goes down is that it's sitting right on that inferior cortex. This is the ideal place for it to be where it's going to most of its stability. This gentleman has such a hard bone, we're going to be fine. But this is where you really want to make sure that it sits well. You don't want it sitting up high. You want it right on that inferior cortex. For it to be nice and secure, we'll slide the tube over the top, and then we'll unpack that into its position and hold everything steady. Let me see. That looks good there. Then we can take out our center guide. And we're going to put our screw in here. And just to hold the trunnion down that's going to go inside the end of the tube here to hold this in place. So what we can do is just kind of set this in position. So we're ready to go. We take our screwdriver, pass it through our handle and slide that down so that we engage our screw. We want to make sure it's engaged properly as you see there. We'll just check and make sure that it's all the way down and seated. And then we'll hold that steady with our hand. All change hands so we can see it well enough. And this will keep it from rotating or tilting. And then we screw it into position. And we just advance that cage screw until it's all the way seated. Okay. So then once we get down to here, it's really nice and secure. And this is just rock solid. You can listen to it squeak its way down. You don't need to be that tight, but this one just happens to be. So we're really happy with how secure that is. And that's all the fixation that we need. Now with anatomic shoulder replacement, you'd have to dial in the humeral head to fit the offset. But we've already chosen exactly where the offset is because we've centered our trunnion right over the cut surface. So now all we have to do is take the head and we place this directly over the top. Make sure there's this little debris as possible. And then we unpack that into its final resting position. Check to make sure it's secure. And that looks great. So now we'll drop this down into place and we'll take out our superior. We'll check. And again we have all the parameters that we're looking for. In the past we have 50% of posterior translation with good bounce back, 40 degrees of external rotation with stability and 60 degrees of internal rotation. Nice and secure. We'll go ahead and bring this in. Now there are a couple of different ways to fix the subscapularis. So this is just nice and very mobile. Nice solid repair should work out extremely well for him.

Total Shoulder Replacement Using Eclipse™ Total Shoulder Arthroplasty System

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