Dr. Robert Tashjian, University of Utah – Salt Lake City, discusses this publication “Humeral Bone Loss in Revision Total Shoulder Arthroplasty: the Proximal Humeral Arthroplasty Revision Osseous inSufficiency (PHAROS) Classification System.
Wright Medical Clinical Summary
doi: 10.1097/CORR.0000000000000590 To view online:
Peter N, Chalmers MD, Anthony A. Romeo MD, Gregory P. Nicholson MD, Pascal Boileau MD, PhD, Jay D. Keener MD, James M. Gregory MD, Dane H. Salazar MD, Robert Tashjian MD Clin Orthop Relat Res. 2019 Feb; 477(2): 432–441. SKU: AP-013589
my name's Bob Tagine. I'm orthopedic shoulder surgeon. That's out of the University of Utah in Salt Lake City. Um, the study that I'm going to discuss is a study that we did specifically looking at patients that underwent revision shoulder Arte plasticky with proximal humerus, bone loss. Uh, some of the issues dealing with proximal humerus bone loss in the setting of revision reverse our capacity is, uh, what's the incidents of bone loss? How do you classify the amount of bone loss that's present on? Then what are the ramifications with regards to treatment for that bone loss? And so there is Currently there are least there was prior to this study. No, um, standardized classifications system for proximal humerus bone loss. So it made it difficult to do research if you can't, uh, classify each of the, uh, defects systematically. And so the purpose of the study was to, uh, first develop a classification system for approximate human bone loss. Second was to assess its reliability and then third to use the classification system that we developed to assess how it changed treatment decisions at the time of a revision. Shoulder surgery. So with regards to the first step. We, uh, got a group of experts together to come up with a classification system that way, then all agreed upon. And Thesis TEM is based upon three levels of bone loss type 12 and three where type one is epiphany. Seal. Uh, type two is, uh, Moustapha Seal. And then type three is Diaw a seal beyond the deltoid insertion. And so we could then start to classify, um, bone defects based on the extent of proximal humerus bone loss. The next step was to take a group of patients. Uh, we looked at over 100 patients that had revision reverse shoulder Arthur plastic performed at the University of Utah in Salt Lake. And we then, uh, looked at the reliability of the classifications system, both integrator and inter rater reliability to see whether or not the classifications system was reliable and we found, uh, high levels of reliability, uh, using the classifications system. We then went back to the same group of patients that we assess the reliability to then use the classifications system to see if there was any decision making treatments that were aligned with each of the different levels of bone loss. Onda. What we found was that there were differences in stem length, the requirement for proximal humerus, Allah, graft and the requirement for two ferocity fixation based upon the system. So if you look at stem length, we found that stem length progressively increased with increasing levels of proximal humerus, bone loss types 12 and three. We found that with regard to the two ferocity fixation, it was much more likely for two ferocity fixation to be required. Uh, do toe Interop uh, very prosthetic fracture in type two, bone loss. So that's meta diacetyl, or type one bone loss, which is a pit sealed bone loss, as opposed to Type three, which is Dia Vasile. And then finally we found the requirement for either proximal humerus, Allah graft or, UH, total human replacement in patients that had bone loss extending below the deltoid insertion. And so how we can move forward with using the data from this is that if we see certain levels of bone loss, type 12 or three, we can start to make assessments of the requirement for need for long stem implants for approximately either approximate human replacement or Allah graft or the requirement for two ferocity fixation based upon the level of bone loss