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JK Rowling. Click on below image to change. Click on image to Zoom. Average Rating Customers. Description Thoroughly updated and expanded into two volumes, the Fourth Edition of Joint Replacement Arthroplasty provides comprehensive coverage of primary and revision arthroplasty procedures for the upper and lower extremities.

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Submit Review Submit Review. Check Delivery Status. Dispatched in working days. Availability In Stock. USD Ship This Item — This item is available online through Marketplace sellers. Temporarily Out of Stock Online Please check back later for updated availability. Overview Thoroughly updated and expanded into two volumes, the Fourth Edition of Joint Replacement Arthroplasty provides comprehensive coverage of primary and revision arthroplasty procedures for the upper and lower extremities.


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Product Details Table of Contents. Show More. Average Review. The Grammont designed shoulder arthroplasty reverses the ball-and-socket relationship of the shoulder. The medialization of the centre of rotation optimizes the deltoid lever arm, and by distalization of the humerus relative to the acromion, re-establishes the tension of the deltoid thus allowing this muscle to produce shoulder range of motion even in the absence of the rotator cuff.

Lowering the humerus lengthens the arm, which can be increased by using a thicker polyethylene component, using a larger or eccentric glenosphere, or positioning the glenosphere on the lower part of the glenoid surface.

Recent Department Publications

S : SS[doi:S Although most of these axillary nerve lesions do not occur as flaccid paralysis, they may be responsible for postoperative pain, weakness, dislocation, or impair rehabilitation. The vulnerability of the axillary nerve compared to the rest of the brachial plexus could thus be due to its particular proximity to the implants or its course around the humerus.

Radial and axillary nerves. The relationship of the axillary nerve to arthroscopically placed capsulolabral sutures. Which joint position puts the axillary nerve at lowest risk when performing arthroscopic capsular release in patients with adhesive capsulitis of the shoulder?

Right path. Right strategy. Right partner.

The anatomic relationship of the brachial plexus and axillary artery to the glenoid. Therefore, the position of the nerve relative to the glenosphere, humerus and implants, has not been quantified. The anatomical position of the axillary nerve could make it more specifically vulnerable to injury due to lengthening of the arm and eventually to compression in cases of secondary impingement. An appreciation of this proximity may help shoulder surgeons avoid iatrogenic injuries that can be devastating.

The aim of this cadaveric study was to evaluate the anatomical relationship between the axillary nerve and the prosthetic components after reverse shoulder arthroplasty. Our hypothesis was that inferior overhang of the glenosphere would decrease the distance between reverse shoulder arthroplasty implants and the axillary nerve.

This relationship may explain the high rate of axillary nerve lesions following reverse shoulder arthroplasty. Eleven fresh frozen human cadaveric shoulders were dissected after thawing.

The mean donor age was Seven of the donors were male and 4 were female. The specimens were mounted in a simulated beach-chair position, secured with a clamp on the medial scapula, and mounted onto an aluminium frame. The size of the metaglene was 27 mm in all cases. The metaglene was implanted low on the glenoid to simulate the ideal position to avoid scapular notching. A 38 mm glenosphere was implanted in 6 cases, and a 42 mm glenosphere was implanted in 5 cases.

Concentric glenospheres were implanted in 6 cases and eccentric glenospheres of 4 mm were used in 5 specimens Table 1. The lateral landmark for the humeral cut was the top of the greater tuberosity. All the humeral stems were non-cemented and implanted high to obtain appropriate deltoid tension.

Total Shoulder Arthroplasty

Non-constrained humeral liners of 6 mm were then placed on the humeral components. The anterior humeral circumflex vessels and the axillary nerve. The nerve originates from the posterior cord of the brachial plexus, runs anteriorly towards the subscapularis muscle and posterior to the axillary artery, passing under the inferior capsule between the glenoid rim and the humeral metaphysis, supplying a branch to the shoulder joint, and crosses the quadrilateral space. At this point, the nerve splits into a main anterior circumflex division, which innervates the deltoid muscle and provides a few cutaneous filaments.

Dissection of the axillary nerve was performed following implantation of the reverse components using a classical deltopectoral approach. The subscapularis tendon had been anatomically repaired to avoid modification of the position of the axillary nerve. The previous deltopectoral incision was enlarged. The upper humeral insertion of the pectoralis major was cut and retracted medially. Tenotomy of the conjoint tendon was performed to provide a better access for the exploration of the brachial plexus. The distance between the inferior borders of the glenoid and the inferior glenosphere was measured.

The axillary nerve was then dissected and the shortest distance to the glenosphere was measured.

Injury to the axillary nerve after reverse shoulder arthroplasty: An anatomical study - EM|consulte

Posterior exposure was then obtained through a vertically oriented incision over the posterior aspect of the shoulder joint. The posterior part of the deltoid was retracted laterally and superiorly allowing exposure of the quadrilateral space. The posterior part of the rotator cuff was not removed.

The main anterior circumflex branch of the axillary nerve was then dissected and isolated Fig. The distance between the nerve and prosthetic components, including polyethylene, were recorded.