Arthroplasty IOT Written Test

Explain the “Love at First Bite” principal when discussing humeral broaching during a Univers ll or Apex TSA.

Broach until satisfactory with rotational/torsinal stability

Is broaching larger than “Love at First Bite” recommended? Why or why not?

Not recommended as the 1.5mm of press fit may cause oversizing and increase fracture risk

List the three key in-situation adjustable features for the Univers ll and Apex humeral systems.

Inclination, Version, Eccentric humeral head offset

What are the humeral head implants in the Univers ll/Apex systems comprised of?

Cobalt chrome or titanium

List/describe three options for Subscapularis take down during the exposure for TSA/rTSA? (Bonus point to describe pros/cons of each)

Tenotomy, Peel, LTO (Lesser Tuberosity Osteotomy)

What are the Univers ll/Apex Glenoids and the Univers Revers humeral cup inserts comprsied of?

UHMWPE (Ultra High Molecular Weight Polyetholene)

The posterior offset humeral cup reamer in the Univers Revers instrument set adds how much offset compared to the neutral humeral cup reaming pin?

2mm

Explain scapular notching and what can be done with the Univers Revers 135° and 155° implant choices to minimize it.

1.) Glenoid neck erosion that’s caused by repetitive mechanical abutment of the humeral component with inferior scapular neck

 2.) 135° with a lateral glenosphere, 155° with a inferior glenosphere

What anatomic landmarks provide the boarders for the exposure field in a shoulder arthroplasty? (i.e, Subscap Boarders)

-Superior: Rotator Interval

-Inferior: Humeral Circumflex Vessels (3 sisters) 

-Medial: Conjoint tendon/Coracoid 

 -Lateral: Biceps/Biceps Groove

Explain the benefits (with respects to fixation and seating) and advantages of the Vaultlock Glenoid component. How do the changes improve glenoid preparation?

1.) Larger flutes, time zero fixation, snap fit, bone grafting

2.) Bone Grafting

The MGS Baseplate is coated with what for bone in-growth?

BioSync

What are the available diameters of the MGS Glenoid Baseplate (not glenosphere)?

24mm and 28mm

Explain Glenohumeral mismatch and the ideal amount as suggested by Dr. Giles Walch.

1.) Difference in radius of curvature between the glenoid and the humeral head

2.) 5.5mm to 7mm

What are the 4 components of a 4-part proximal humeral fracture?

Humeral Head, Humeral Shaft, Lesser Tuberosity, Greater Tuberosity

What is the Walch classification of this glenoid morphology?

B2

Using the torque indicating driver, the screws in the Universal Glenoid Univers Revers Baseplate should be tightened to what indicated torque?

Between 3Nm and 5Nm

What is “Superior Escape” and what muscle/tendon dysfunction causes it?

1.)  Proximal Humeral Migration

 2.) Supraspinatus

Describe the lateral offset options built into the MGS glenoid baseplate (not the glenosphere).

Standards, +2mm and +4mm

List a pro and con of using the Universal Convertible Baseplate in an anatomic total shoulder reconstruction.

Pro: Bone grafting, convertible, lateralization if you need it

Con: Overstuffing

True/False: When sizing the Eclipse humeral implant, it is important to overhang the humeral cortex by 1mm in order to assure proper cortical contact.

False

What are indications for performing a revers total shoulder arthroplasty? I.e. What are the conditions that a patient may have that require the procedure?

Cuff Arthropathy, Irreparable rotator cuff tear not indicated for SCR, Proximal Humeral Fracture

What Glenosphere diameters are available in the MGS Revers Shoulder Arthroplasty?

33, 36, 39, 42, 45

When sizing the central cage screw in an Eclipse the marking sits between 2 sizes, what would you instruct the surgeon to use?

Downsize to the smaller size option

List examples of surgical steps that can be taken to provide appropriate glenoid exposure?

The Great 8.....

            1.) Sub deltoid/Sub acromial adhesions

            2.) Pec Major Tendon release

            3.) Rotator Interval release to the base of the Coracoid 

            4.) Biceps tenotomy/tenodesis 

            5.) Subscapularis/Anterior capsule release

            6.) Inferior capsule release from Humerus

            7.) Humeral Head Osteotomy 

            8.) Inferior capsule release from Glenoid

What types of VIP planning options are available for surgeons to employ in the operating room during arhtroplasty cases?

Plan only, 5D calibrator, 3D model to calibrate

List/describe options of available augmented glenoid components for aTSA/rTSA.

- Vaultlock: Two Half Wedge......15, 25

- MGS: Two Full....10, 20 

             Three Half Wedge.....15, 25, 35