BIO-RSA
Educational Conference
Bone & Joint Clinic of Houston
4/16/2012
62 yo female with right
shoulder pain
-Massive cuff tear on CT
arthrogram
-h/o RA, CABG
CT scan
Patient
Example of A2 Glenoid
A2
Post-Op RSA with Bone graft in Place
Basic Principles of RSA
 reduce
-- torque on the glenoid component and
increase the deltoid lever arm, overcoming weak
or absent rotator cuff musculature
1. Medialization of the GHJ center of
Rotation
2. Lowering of the humerus
Issues found with a Medialized Design
 Inferior Scapular Notching (50-96%)
 Limited ROM secondary to Impingement
 Instability (3-6%) – Poor tissue
tension/impingement
 Contour/Cosmesis
Increased-Offset (Lateralized) RSA
Bony
 autogenous bone graft
harvested from the humeral
head on a specifically
designed baseplate with a
long central peg
 keeps the center of rotation
at the glenoid boneprosthesis interface once the
bone graft has healed
Metallic/Prosthetic
 achieved by increasing the
offset of the glenosphere
and/or baseplate (metallic
lateralization)
 disadvantage of increasing
torque or shear force applied
to the glenoid component
and potentially increasing the
risk of glenoid loosening
Glenoid Morphology (Walch et al.)
Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis
Gilles Walch, MD, Roger B a d e t , MD, Aziz B o u l a h i a , MD, and A l f r e d Khoury, MD
The Journal of Arthroplasty Vol. 14 No. 6 1999
A1
 Walch et al.
A2
 Walch et al.
B1
 Walch et al.
B2
 Walch et al.
C
 Walch et al.
BIO-RSA Technique
Baseplate
BIO-RSA Technique
BIO-RSA Technique
BIO-RSA Technique
Post-Op RSA with Bone graft in Place
Bony Increased-offset Reversed Shoulder Arthroplasty
Minimizing Scapular Impingement While Maximizing
Glenoid Fixation
CORR 2011
Pascal Boileau MD, Gre´gory Moineau MD,
Yannick Roussanne MD, Kieran O’Shea FRCSI
Boileau et al.
 Prospectively followed 42
 Minimum 2 year follow-up
patients with rotator cuff
deficient shoulder treated
with BIO-RSA
 Average Age 72 (52-86 yo)
 Clinical (ROM and
Constant-Murley score),
radiographic and CT
assessment
(24-40 months)
 Pre-op daignosis included
CTA, sequela of proximal
humerus fractures, failed
RTC surgery
Results
Boileau et al.
 98% complete graft incorporation
 No graft resorption, glenoid loosening, or
postoperative instability was observed
 Inferior scapular notching found in 19%
 Improved clinical scores on ROM
Thank You