PREVIEW ONLY - World Health Webinars...Suretac Smith and Nephew Poly-glconate-B (PLA) Bioknotless...

11/08/2013

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“Surgery for Primary Shoulder Instability”

Presented by: Prof. George Murrell MBBS (Adel), MD (UNSW), DPhil (Oxon)

Will commence LIVE from Sydney, Australia at 8pm AEST

Andrew Ellis BSc (Ex. Sci), M. Phty

World Health Webinars CEO

World Health Webinars Host

Musculoskeletal Physiotherapist

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Prof George Murrell

• Director of the Orthopaedic Research Institute at St George Hospital

• Professor at the UNSW

• 1984 South Australian Rhodes Scholar

• completed a DPhil (PhD) at Oxfor and was awarded the Royal College of Surgeons Arris and Gale medal.

• gained a National Institutes of Health First Award

• serves on the editorial boards of the Journal of Shoulder and Elbow Surgery, Shoulder and Elbow, Techniques in Shoulder and Elbow Surgery and the British Journal of Sports Medicine.

• His team has won over 30 awards for their work and his fellowship program attracts surgeons from around the world.

Orthopaedic Surgeon

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Surgery for Primary Shoulder Instability

Gleno-humeral Ligaments

Ligaments with abduction

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Proprioception

Reduced in a shoulder that has dislocated

Restored following surgical repair

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Shoulder Instability

Diagnosis

• History

• Clinical exam

Mechanism of Injury Load and Shift

Apprehension sign PREVIEW ONLY


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Augmentation sign

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Relocation sign Treatment

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Non-operative Rx

Increasing the rigidity of immob

No change in rec rate

Increasing the length of immob

No change in rec rate

No effect on reduced proprioception

Eiji Itoi, MD, PhD

Bankart

lesion

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Immobilization in ER

Prototype brace (2003 – 2004)

Itoi et al: JBJS-Am 2007

ER Brace

Immob in ER reduces RR by 38-49%

Length of immob = 3 weeks

Position of immob

Method of immob

Shoulder Brace ER® (ALCARE)

(2004 – Present)

Non-operative Rx

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Open stabilisation

Arthroscopic stabilisation

Putti Platt

Open capsular Shift

Open Bankart Repair

Bankart Repair

Tacks, Metal anchors, Bioabsorbable anchors

http://images.google.co.uk/imgres?imgurl=http://lipscombclinic.com/sports/Articles/Anatomy/ShoulderInstability/fig4a.jpg&imgrefurl=http://lipscombclinic.com/sports/Articles/Anatomy/ShoulderInstability/shoulder1.htm&h=233&w=246&sz=6&hl=en&start=1&tbnid=I5zu58hOSrdMgM:&tbnh=104&tbnw=110&prev=/images?q=arthroscopic+stabilization&svnum=10&hl=en&lr=&sa=G

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Bristow Putti-Platt

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Open Bankart Repair Arthroscopy

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Aims

Determine the clinical outcomes of four (4) knotless suture anchors

Karin Peters

Methods

Suretac Smith and Nephew Poly-glconate-B (PLA)

Bioknotless DePuy Mitek Poly-D-L-lactic acid (PLLA)

OPUS® Labrafix® ArthroCare Stainless steele

Pushlock Arthrex PEEK

Methods





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Methods



OPUS® Labrafix® ArthroCare Metal


Methods



OPUS® Labrafix® ArthroCare Metal


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Methods





Ab

sorb

able

Pe

rman

ent

Surgery - Interscalene Block Beach Chair

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Primary Outcome

Stability

Complications

Intra-operative Suretac 3 cases: tac pulled out

Bioknotless 3 cases: tip of inserter

broke off

Post-operatively Pushlock 1 case of adhesive

capsulitis

Labrafix 1 case loose anchor

Suretac 1 case of synovitis

secondary to

Suretac anchors

Survival Analysis

Time

0 2 4 6 8 10 12

Surv

ival

0,0

0,2

0,4

0,6

0,8

1,0SURETAC

BIOKNOTLESS

PUSHLOC

OPUS LABRAFIX

20%

40%

60%

80%

100%

(Years)

*** **

Kaplan-Meier analysis for redislocation

Time (years)

Survival Analysis

Time

0 2 4 6 8 10 12

Surv

ival

0,0

0,2

0,4

0,6

0,8

1,0SURETAC

BIOKNOTLESS

PUSHLOC

OPUS LABRAFIX

20%

40%

60%

80%

100%

(Years)

*** **


Time (years)

Survival Analysis

Time

0 2 4 6 8 10 12

Surv

ival

0,0

0,2

0,4

0,6

0,8

1,0SURETAC

BIOKNOTLESS

PUSHLOC

OPUS LABRAFIX

20%

40%

60%

80%

100%

(Years)

*** **


Time (years)

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Survival Analysis

Time

0 2 4 6 8 10 12

Surv

ival

0,0

0,2

0,4

0,6

0,8

1,0SURETAC

BIOKNOTLESS

PUSHLOC

OPUS LABRAFIX

20%

40%

60%

80%

100%

(Years)

*** **


Time (years)

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Survival Analysis

Time

0 2 4 6 8 10 12

Surv

ival

0,0

0,2

0,4

0,6

0,8

1,0SURETAC

BIOKNOTLESS

PUSHLOC

OPUS LABRAFIX

20%

40%

60%

80%

100%

(Years)

*** **


Time (years)

Survival Analysis

Time

0 2 4 6 8 10 12

Surv

ival

0,0

0,2

0,4

0,6

0,8

1,0SURETAC

BIOKNOTLESS

PUSHLOC

OPUS LABRAFIX

20%

40%

60%

80%

100%

(Years)

*** **


Time (years)

***

***

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Survival Analysis

Time

0 2 4 6 8 10 12

Surv

ival

0,0

0,2

0,4

0,6

0,8

1,0SURETAC

BIOKNOTLESS

PUSHLOC

OPUS LABRAFIX

20%

40%

60%

80%

100%

(Years)

*** **


Time (years) Time

0 2 4 6 8 10 12

Surv

ival

0,0

0,2

0,4

0,6

0,8

1,0SURETAC

BIOKNOTLESS

PUSHLOC

OPUS LABRAFIX

20%

40%

60%

80%

100%

(Years)

No significant differences between the groups

Kaplan-Meier analysis for revision surgery

Summary

Bankart lesion

Summary

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Summary

Restore detached labrum

Avoid biodgradable anchors

Summary

Metal or PEEK

Excellent outcomes

Minimal complications

< 6-8% recurrence at 4 years

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Summary

Ongoing follow-up essential

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THANK YOU

Live Q & A With George Murrell

Coming up next week

11/08/2013

12

Facebook, Twitter, LinkedIn, Google +

Live Q & A With George Murrell

Thank you

From George Murrell

&

World Health Webinars Australia http://worldhealthwebinars.com.au

PREVIEW ONLY - World Health Webinars...Suretac Smith and Nephew Poly-glconate-B (PLA) Bioknotless...

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