2018 Meeting Programme

Thursday 11 October 2018


08.30 | Registration


08.50 | Welcome


09.00 | Session 1 | Biomechanics

  • 09.00 Centre of rotation.
    • History and Evolution of Reverse.
    • Medialisation of COR.
    • Inferiorisation of COR
    • Lateralization of COR Humeral lateralization.
    • Glenosphere size and shape (concentric vs eccentric).
    • Hemisphere.
    • More than hemisphere.
    • Constraint.
    • Glenoid inclination.
    • Glenoid version.
    • Neckshaft angle.
    • Inlay-Onlay
  • 09.15 Biomechanical concepts: How different designs could affect functional results of reverse.
  • 09.30  Round Table Discussion  Biomechanics.
    • Which are the critical points?
    • Medialisation COR.
    • Lateralization COR.
    • Humeral lateralization.
    • Wrapping effect.
    • Tensioning cuff
  • Inferiorisation. Glenoid inclination. Role of subscapularis
  • 10.00  Discussion  Questions and discussion
  • 10.15 Surgical exposure.
    • Tips and Tricks.
    • Preop planning.
    • Deltopectoral versus Superior Approach.
    • How to get to the Glenoid and Expose it.
    • Protecting the axillary nerve and Brachial plexus
  • 10.30  Discussion  Questions and discussion

10.45 |  | Coffee

11.15 | Workshop 1


12.15 | Session 2 | Indications of Reverse

  • 12.15 Cuff arthropathy. Irreparable rotator cuff tear. Non arthroplasty procedures. When do we use them?
  • 12.30 OA. What affects my decision making between anatomical and reverse. Assessment glenoid anatomy. Glenoid wear. Rotator cuff asessment. Is reverse first choice in over 70s?
  • 12.45 Trauma and Sequeli of Trauma. Which fractures benefit from reverse. Sequeli: Post conservative treatment. Post fixation. Post hemiarthroplasty.

13.00 |  | Lunch

  • 14.00  Round Table Discussion  Clinical session including different scenarios. Presentation of:
    1. OA 72y female. Correct glenoid. Small cuff tear clinically not significant, diagnosed on MRI
    2. OA 55 y male. Glenoid type B2 or C2 with 30 degrees retroversion
    3. Large rotator cuff tear in a 65-year-old. Pain and poor functional balance after suprascapular nerve blocks and radiofrequency ablation. Hamada type II or III. Discuss about balloon/ SCR/Reverse
    4. Fresh 4-part valgus impacted fracture in a 65 year old female in good health
    5. Sequelae of a conservatively treated fracture with greater tuberosity completely displaced and vert poor function and pain in a 78 year old female

15.00 | Session 3 | Complications of Reverse. Where do we have to look into?

  • 15.00 Notching.
    • Definition of notching.
    • Implications
  • 15.15 Infection.
    • Is infection rate higher in reverse?
    • Early and late infection.
    • Strategies to define infection: Lab, imaging, samples.
    • One stage revision.
    • Two stage revision.
    • Relevance of P.acnes and other low grade pathogens in shoulder infection.
  • 15.30 Impingement.
    • Acromial impingement
    • Conjoined tendon impingement
    • Does it affect functional result?

15.45 | Workshop 2

Friday 12 October 2018


09.00 | Session 3 | Continued

  • 09.00 Instability.
    • Early vs late instability.
    • Which are the structures that provide stability in reverse.
    • Role of: CA ligament, subscapularis, deltoid, conjoined tendon, remnants of cuff, prosthesis design, wrapping effect.
    • Strategies to prevent instability.
  • 09.15 Scapular fractures.
    • Acromial and spine of scapula stress fractures due to over tensioning of deltoid.
    • Types-Classification of fracture (I-II-III).
    • Consequences.
    • Management of these fractures.
    • Relevance of superior screw length on production of medial spine of scapula fractures

09.30 | Session 4 | Bone loss. Glenoid. Humerus. Surgical management

  • 09.30 Glenoid Bone grafting.
    • Retroverted glenoids.
    • Upward tilted glenoids.
    • Contained and uncontained defects.
    • Use of autograft.
    • Selection of autograft.
    • Allograft.
    • One stage reconstruction.
    • Two stage reconstruction.
    • Where are the limits?
  • 09.45 Glenoid Augments.
    • Baseplate metallic augments shapes and sizes.
    • Pro and cons and comparison to grafts.
    • Retroverted and upward tilted glenoids.
    • Major defects.
  • 10.00  Round Table Discussion  Clinical session including different scenarios and presentation of a few clinical cases for discussion.
    1. More than 40 degrees retroverted glenoid C2 in a 62 year old lady with minimal arthritic changes. Pain and very limited function
    2. Posterosuperior wear in a very far evolved RCA in a 80 years old lady with poor bone quality.
    3. Chronic anterior dislocation with significant bone loss
    4. Chronic posterior dislocation.
    5. Badly medially and superiorly eroded glenoid in a Rheumatoid patient.
  • 10.45  Discussion  Question and answer session.

11.00 |  | Coffee

11.30 | Workshop 3


12.30 |  | Lunch

13.30 | Session 5 | Proximal Humeral Replacement

  • 13.30 How to remove a well fixed humeral implant
  • 13.45 Periprosthetic Fracture. How to treat
  • 14.00 Proximal Humeral Replacement.
    • Situations when PHR is needed.
    • Humeral bone loss as a result of: Fracture, Loosening-Osteolysis, Infection, Tumour

14.15 | Session 6 | Rehabilitation. NJR. Standard of Reverse. How do we compare to Hip Replacement?

  • 14.15 Rehabilitation after reverse.
    • Key elements: Pain, stability and preop situation.
    • Rehab programme in standard reverse.
    • Special situations: Instability, complex pain (neuropathic, central pain)
  • 14.45 NJR.
    • How do we compare to Hip Replacements?
    • Current data.
    • How are we collecting NJR for reverse?
    • Problems.
    • The future.
    • Strategy

15.00 Close