Authors’ Disclosure Statement: Dr. Goldberg reports that he is a paid consultant and has intellectual property assigned to, and stock and stock options in, Catalyst OrthoScience, the manufacturer of the implant and instruments shown in this article. Dr. Baranek reports no actual or potential conflict of interest in relation to this article.
Dr. Goldberg is Chief of Orthopedic Surgery, Physicians Regional Medical Center, Naples, Florida. Dr. Baranek is a Resident Physician, Department of Orthopedic Surgery, Columbia University-New York Presbyterian Medical Center, New York, New York.
Address correspondence to: Steven S. Goldberg, MD, Physicians Regional Medical Center–Pine Ridge, 6101 Pine Ridge Road, Naples, FL 34119 (tel, 239-348-4253; fax, 239-304-4929; email, Drstevengoldberg@gmail.com).
Steven S. Goldberg MD Eric S. Baranek MD . Total Shoulder Arthroplasty Using a Bone-Sparing, Precision Multiplanar Humeral Prosthesis. Am J Orthop. February 1, 2018
References
The implant respects the relationship of the rotator cuff insertion and has a recessed superior margin to keep both the implant and the saw blade 3 mm to 5 mm away from the supraspinatus fibers to protect the rotator cuff from iatrogenic injury.
TECHNIQUE
The technique described in this article uses the Catalyst CSR Total Shoulder System (Catalyst OrthoScience), which was cleared to treat arthritis of the shoulder by the US Food and Drug Administration in May 2016.
A standard deltopectoral incision is made, and the surgeon dissects the interval between the pectoralis major medially and the deltoid laterally. The subscapularis can be incised by tenotomy; alternatively, the surgeon can perform a subscapularis peel or a lesser tuberosity osteotomy using this technique.
Once the glenohumeral joint is exposed, the surgeon delivers the humeral head anteriorly. A preferred method is to place a Darrach retractor between the humeral head and the glenoid, and a cobra or a second Darrach retractor behind the superolateral humeral head superficial to the supraspinatus tendon. By simultaneously pressing on both retractors and externally rotating the patient’s arm, the humeral head is delivered anteriorly. Osteophytes on the anterior and inferior edge of the humeral head are generously removed at this time using a rongeur.
Using a pin guide, the long 3.2-mm guidewire pin is drilled under power into the center of the articular surface. The pin guide is then removed, leaving the pin in the center of the humerus (Figure 3).
