Arthroscopic Surgery for the

Shoulder Joint
Team 5
Sam Graham

Matthew Ratcliff

Sarah Gadd

Andrew Rendall

Sam Wilson

Mohammad N.R.Khan

Anatomy of the Shoulder Joint

Anatomy of the Shoulder Joint

Types of Shoulder Arthroplasty

Hemi Arthroplasty

Total
Arthroplasty

Reverse Geometry

Open shoulder surgery

Repair injuries of shoulder

One or several incisions made

Arthroplasty
replaces defective joints with implants
Other techniques can be used to remodel the joint surface

Arthroscopic Surgery
Keyhole Surgery
instruments enter the patient through various portals
Surgical Considerations
Portal Placement-dependent on injury
Patient Positioning

Rotator Cuff Repair

Materials
Often a metal-polyethylene joint although there have
been developments in metal-metal and ceramics
Chosen for key properties of strength, bioinductive for
bone growth, biocompatibility, surface finish, corrosion
and fatigue resistance.
Suture anchors can be bioabsorable and biodegradable
Manufactured through many processes to national
regulators standards

Arthroscopic vs traditional surgery

Advantages
Less infections

Less post-operative pain

Smaller scar

Faster recovery

Reduced soft tissue damage

Better pain relief and patient

satisfaction

Disadvantages
Less versatile

Some procedures not possible

Better outcomes with certain

open procedures (Laterjet vs
arthroscopic bankart repair)

Expensive to train surgeons

and buy new equipment

Rotator cuff tears

Previously repaired by open surgery
New techniques being developed with
biological scaffolds
Cannot address co-existent
glenohumeral pathology

Complications
No less severe than with open surgery
Revision surgery unsuccessful
Infection & thromboembolic complications (very rare)

Future Strategies
Single-row

Double-row
Improved techniques
Lower re-tear rates
Increased number of
suture anchors

Images adapted from Arthex.com

Materials with magnesium

Biocompatible
Osteoinductive
Beneficial in titanium implants
Potential use in Hydroxyapaetite
(HA)

FSEM micrograph
Mg-HA
Image adapted from (Zhao et al., 2013)

Conclusion/Summary Slide?
Guidelines for presentation (from blackboard)
The ppt presentation guidelines mention a conclusion (thought we
can add some after this has been written in the report)
References should be acknowledged on each slide
Should be clear with a logical structure
Clear and appropriate visual aids

Thank you for listening

Are there any questions?

Ghost Slides

Other structures contributing to

stability

Biceps Brachii
Glenoid Labrum
Ligaments

Portals for Rotator Cuff Surgery

Portal

Uses

Posterior (P)

Primary viewing portal

Instrumental access to the articular surface of the infraspinatus and
periglenoid capsule
View the articular surface of the infraspinatus and posterior capsule
Instrumental access to the periglenoid capsule, supraspinatus and
infraspinatus tendons
View entire subacromial space, acromio-clavicular joint and extraarticular biceps
Instrumental access to the anterior acromion and posterior bursa
View and instrument the subacromial space, acromio-clavicular joint and
extra-articular biceps
Primary viewing portal for rotator cuff pathology
Primary instrument access to the greater tuberosity of the joint, where
the drill, tap and anchor insertion takes place

Anterior (A)

Posterior Subacromial (PSA)

Lateral Subacromial (LSA)

Posterolateral Subacromial (PLSA)
Lateral Acromial (LA)

Reasons for Open Surgery

Glenoid & humeral loosening
Glenoid wear
Instability
Infection
Rotator cuff tears
Indications for Shoulder Arthroplasty
Rotator cuff tear arthroplasty
Avascular necrosis
Post-traumatic arthritis
Severe proximal humeral fractures
Osteoarthritis & Rheumtoid arthritis
Avascular necrosis

Regulations
ISO 9000 Quality Management
ISO 17853:2011 Wear of Implant Materials
ISO 14283:2004 Fundamental Principles of Implants
for Surgery
ISO 13485:2003 Medical devices quality
management systems
Conformit Europene (CE)
Shoulder implants are class III indicating a high risk
level and requiring human clinical investigations
before certification

Manufacturing and Regulations

Adhere to national regulators using standards such as
Conformit Europene and ISO (9000, 17853:2011,
14283:2004, 13485:2003)
Clean Room Environment
Each component is fabricated using a series of processes
due to the precision required

Future Strategies
Platelet-rich plasma (PRP)

Antibiotic bone cements

Reduce infection
Infection is a common
complication

Bone grafts to repair bone loss

Images adapted from (Tokish et al., 2014)