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Stay Out of Trouble_Reverse Shoulder Arthroplasty

Video Author: Enrico Bellato, MD
Published on: 09.26.2018
Associated with: JAAOS - Journal of the American Academy of Orthopaedic Surgeons. 26(19):706, October 1, 2018

We discuss the key steps the surgeon should follow to perform a safe, successful primary reverse shoulder replacement. Proper patient selection, preoperative evaluation, and surgical technique are essential. CT is used to evaluate for glenoid version and possible glenoid bone defects, and in planning patient-specific instrumentation. Proper patient positioning is essential to avoid intraoperative patient shifting and neck stretching and to allow free shoulder range of motion. The deltopectoral or anterolateral approach can be used.

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Creator: Enrico Bellato, MD
Duration: 00:26
We discuss the key steps the surgeon should follow to perform a safe, successful primary reverse shoulder replacement. Proper patient selection, preoperative evaluation, and surgical technique are essential. CT is used to evaluate for glenoid version and possible glenoid bone defects, and in planning patient-specific instrumentation. Proper patient positioning is essential to avoid intraoperative patient shifting and neck stretching and to allow free shoulder range of motion. The deltopectoral or anterolateral approach can be used.
Creator: Gianluca Vadala, MD
Duration: 00:25
The aim of this video is to show the surgical operative technique of anterior cervical diskectomy and fusion (ACDF) in a 45-year-old man affected by C5-C6 disc herniation with myeloradiculopathy, who suffered from brachialgia, pectoral fasciculation, and weakness at the inferior limbs associated to ambulation impairment.
Creator: Kartik Shenoy, MD
Duration: 00:26
Vertebral column resection (VCR) is the most powerful tool in the spine surgeon’s armamentarium for deformity correction. In patients with severe, rigid spinal deformity, in which traditional osteotomies cannot achieve adequate correction without complication, VCR may be indicated. The posterior technique was popularized by Suk in 2002. We present a unique case in which proximal junctional kyphosis developed after a T4 VCR and T1-T10 instrumented fusion and the patient subsequently underwent a second VCR at T2 with extension of the fusion construct to restore sagittal alignment.
Creator: Giorgio Burastero, MD
Duration: 00:25
Femoral and/or tibial massive bone defects (ie, Anderson Orthopedic Research Institute type F2B to F3/T2B to T3) are commonly seen when total knee arthroplasties (TKAs) are revised because of infection or in cases in which a second or third revision is performed. We present a new, custom-made option for use in cases of complex metadiaphyseal bone defects. We show the clinical and radiologic results achieved to date using this new system. Management of major bone defects in revision TKA remains challenging. The new approach we describe could help improve clinical outcomes and patient satisfaction when managing the most challenging cases.
Creator: Michael A. Zacchilli, MD
Duration: 0:25
Osteochondral allograft implantation has emerged as a promising treatment option for large osteochondral lesions of the talus (OLTs) because it provides both structural support as well as self-sustaining, viable chondrocytes. However, adequate access to the talar dome is critical for allograft implantation. Medial malleolar osteotomy has emerged as a reliable and safe method for exposure of the talar dome and shoulder region. We demonstrate a technique for fresh osteochondral allograft implantation of a large OLT through a medial malleolar osteotomy. Implantation often requires adequate exposure afforded by a medial malleolar osteotomy. Results are contingent on careful and consistent technique.
Creator: Davide Blonna, MD
Duration: 0:27
The purpose of this educational video is to report our findings regarding the real anatomy of the lateral collateral ligament of the elbow and discuss how these findings affect our decision making regarding the best surgical approach to the lateral elbow.
Creator: Manuel Villanueva, MD, PhD
Duration: 0:27
Ultrasound-guided proximal lengthening in patients with less marked gastrocnemius contracture demonstrated excellent preliminary results in most patients. The main indications for the surgical procedures were gastrocnemius contracture, noninsertional Achilles tendinopathy, equinus foot, plantar fasciitis, metatarsalgia, and tarsal tunnel syndrome. Pain and function improved significantly in all patients. There are few complications and contraindications. Bilateral procedures may be performed alone or in combination with other ultrasound-guided surgical techniques in an outpatient setting, with proximal or distal ultrasound-guided procedures. The procedure carries a steep learning curve.
Creator: Amy Wasterlain, MD
Duration: 0:30
Although total femur arthroplasty (TFA) has traditionally been thought of as a treatment for bone tumors of the thigh, it is becoming a versatile and effective technique in the management of complex periprosthetic femur fractures. Adult reconstruction indications include periprosthetic fractures with severe bone loss or comminution that precludes plate fixation and as a two-stage salvage procedure for persistent periprosthetic infection. The major complications associated with TFA include infection, hip or knee dislocation, limb-length discrepancy, fracture or failure of the prosthesis, and abductor muscle failure. TFA can be a useful salvage technique for the management of complex periprosthetic femur fractures.
Creator: William H. Marquez, MD
Duration: 0:24
Tears of the gluteus medius and minimus tendons are a common cause of greater trochanteric pain syndrome. Causes of injury related to this pathology include excessive tension on the iliotibial band; limb-length discrepancy; structural abnormalities in the lumbar spine or hip resulting in chronic stress in the trochanteric insertion of these tendons; sports activities that overload these muscles; direct trauma or abduction trauma; microcrystal deposition; and reduced vasculature of the gluteus medius tendon in the elderly, with resulting decreased healing potential. Endoscopic repair is an effective treatment option for patients with a gluteus medius tendon tear.
Creator: Han-Jun Lee, MD
Duration: 0:25
Several methods exist for correcting severe varus deformity during total knee arthroplasty (TKA). Tibial subperiosteal stripping of the superficial medial collateral ligament (MCL) can lead to excessive release, as can traditional pie-crusting of the superficial MCL using a blade. We performed selective and sequential medial release using the pie-crusting method with multiple needle punctures and investigated the effectiveness and safety of the technique during primary TKA. There were no complications, that is, no hematoma formation, conversion to a constrained implant, or late instability. The technique was safe, reproducible, and effective in treating severe varus deformity during primary TKA.
Creator: Albert Lin, MD
Duration: 3:14
Ultrasound examination of the shoulder, including placement of the ultrasound probe for optimal visualization of the shoulder anatomy.
Creator: Kathleen Rickert, MD
Duration: 00:32
The video shows the modified Broström technique of direct, anatomic repair to manage chronic lateral ankle instability in the immature athlete.
Creator: Luca Labianca, MD
Duration: 00:28
The Pemberton pericapsular osteotomy is performed to manage acetabular deficiency in patients with developmental dysplasia of the hip. The video shows step by step the timeline of the procedure, beginning from the incision (ie, bikini incision) made just distal and parallel to the anterior superior iliac spine. Key points, as the LFCN isolation or the correct use of Cobb elevators to expose the anterior inferior iliac spine, are clearly shown. Moreover, we show how fluoroscopic imaging aids in determining the osteotomy cut, in addition to a wide and clear explanation, with several different views of the osteotomy itself.
Creator: Michael T. Archdeacon, MD
Duration: 12:01
The modified Stoppa, or anterior intrapelvic, approach to the acetabulum provides straightforward anatomic exposure that can be used for direct access to the pelvic brim, posterior column of the acetabulum, and the quadrilateral surface. The improved visualization provided by this approach facilitates fracture reduction and stabilization. This approach does not require surgical dissection of the inguinal canal and femoral neurovascular bundle. A traditional lateral window may be incorporated to facilitate reduction and stabilization of anterior column fracture. This anterior intrapelvic approach is contraindicated in fractures with posterior-only patterns that exit below the ischial spine.
Creator: Davide Blonna, MD
Duration: 0:27
Our technique was developed to use the advantages of traditional percutaneous pinning (eg, temporary fixation, preservation of the soft tissues, better cosmesis) and improve its limitations, in particular, the weak fixation in osteoporotic bone. The main modifications are the use of long threaded pins to achieve purchase in good-quality bone beneath the articular surface of the humeral head and in the lateral cortex of the metaphysis, which helps to obtain strong bicortical fixation, as well as the use of a dedicated external fixator to further increase pin stability.
Creator: Mohamed Kenawey, MD
Duration: 0:24
This video presents three modifications of the surgical technique for combined glenoid anteversion osteotomy and tendon transfer for the management of brachial plexus birth palsy.
Creator: Cesare Faldini, MD
Duration: 0:28
The video shows the surgical correction of a double major scoliosis deformity in a 14-year-old girl with normal kyphosis and type C lumbar modifier. Double major curve involves a major thoracic structural curve and a minor thoracolumbar or lumbar structural curve. The axial rotation of the vertebrae and ribs induce the rib hump deformity in the thoracic region and thoracolumbar passage, which requires particular attention at the time of vertebral rotation. To correct the deformity in all three planes, the surgical correction is performed by applying simultaneous dual-rod and direct vertebral rotation.
Creator: Matthew T. Burrus, MD
Duration: 0:27
For severe trochlear dysplasia with patellar instability, a sulcus-deepening trochleoplasty is a reliable surgery to correct a patient’s abnormal distal femoral morphology. In previous studies, redislocation rates after this procedure have been universally low. In this video, the surgical technique is presented in detail, and one center’s experience with this procedure is examined.
Creator: Cesare Faldini, MD
Duration: 0:26
Retrospective evaluation of 13 patients (mean age, 34.8 years) treated with tibialis posterior tendon transfer to manage foot drop deformity secondary to insufficiency of the muscles of the anterior compartment of the leg. The tibialis posterior tendon was transferred onto the intermediate or lateral cuneiform, then pulled out through a transosseous tunnel and fixed at the plantar surface. Seven patients underwent Achilles tendon lengthening before tibialis posterior transfer. Results were excellent in five patients, good in five, fair in two, and poor in one based on the Stanmore scale (0 to 100). No major complications occurred.
Creator: Braden E. Hartline, MD
Duration: 0:31
This video shows a technique of using a fixed-angle blade plate to treat a proximal femur fracture.



Creator: Enrico Bellato, MD
Duration: 00:26
We discuss the key steps the surgeon should follow to perform a safe, successful primary reverse shoulder replacement. Proper patient selection, preoperative evaluation, and surgical technique are essential. CT is used to evaluate for glenoid version and possible glenoid bone defects, and in planning patient-specific instrumentation. Proper patient positioning is essential to avoid intraoperative patient shifting and neck stretching and to allow free shoulder range of motion. The deltopectoral or anterolateral approach can be used.
Creator: Gianluca Vadala, MD
Duration: 00:25
The aim of this video is to show the surgical operative technique of anterior cervical diskectomy and fusion (ACDF) in a 45-year-old man affected by C5-C6 disc herniation with myeloradiculopathy, who suffered from brachialgia, pectoral fasciculation, and weakness at the inferior limbs associated to ambulation impairment.
Creator: Michael A. Zacchilli, MD
Duration: 0:25
Osteochondral allograft implantation has emerged as a promising treatment option for large osteochondral lesions of the talus (OLTs) because it provides both structural support as well as self-sustaining, viable chondrocytes. However, adequate access to the talar dome is critical for allograft implantation. Medial malleolar osteotomy has emerged as a reliable and safe method for exposure of the talar dome and shoulder region. We demonstrate a technique for fresh osteochondral allograft implantation of a large OLT through a medial malleolar osteotomy. Implantation often requires adequate exposure afforded by a medial malleolar osteotomy. Results are contingent on careful and consistent technique.
Creator: Davide Blonna, MD
Duration: 0:27
The purpose of this educational video is to report our findings regarding the real anatomy of the lateral collateral ligament of the elbow and discuss how these findings affect our decision making regarding the best surgical approach to the lateral elbow.
Creator: Manuel Villanueva, MD, PhD
Duration: 0:27
Ultrasound-guided proximal lengthening in patients with less marked gastrocnemius contracture demonstrated excellent preliminary results in most patients. The main indications for the surgical procedures were gastrocnemius contracture, noninsertional Achilles tendinopathy, equinus foot, plantar fasciitis, metatarsalgia, and tarsal tunnel syndrome. Pain and function improved significantly in all patients. There are few complications and contraindications. Bilateral procedures may be performed alone or in combination with other ultrasound-guided surgical techniques in an outpatient setting, with proximal or distal ultrasound-guided procedures. The procedure carries a steep learning curve.
Creator: Amy Wasterlain, MD
Duration: 0:30
Although total femur arthroplasty (TFA) has traditionally been thought of as a treatment for bone tumors of the thigh, it is becoming a versatile and effective technique in the management of complex periprosthetic femur fractures. Adult reconstruction indications include periprosthetic fractures with severe bone loss or comminution that precludes plate fixation and as a two-stage salvage procedure for persistent periprosthetic infection. The major complications associated with TFA include infection, hip or knee dislocation, limb-length discrepancy, fracture or failure of the prosthesis, and abductor muscle failure. TFA can be a useful salvage technique for the management of complex periprosthetic femur fractures.
Creator: William H. Marquez, MD
Duration: 0:24
Tears of the gluteus medius and minimus tendons are a common cause of greater trochanteric pain syndrome. Causes of injury related to this pathology include excessive tension on the iliotibial band; limb-length discrepancy; structural abnormalities in the lumbar spine or hip resulting in chronic stress in the trochanteric insertion of these tendons; sports activities that overload these muscles; direct trauma or abduction trauma; microcrystal deposition; and reduced vasculature of the gluteus medius tendon in the elderly, with resulting decreased healing potential. Endoscopic repair is an effective treatment option for patients with a gluteus medius tendon tear.
Creator: Han-Jun Lee, MD
Duration: 0:25
Several methods exist for correcting severe varus deformity during total knee arthroplasty (TKA). Tibial subperiosteal stripping of the superficial medial collateral ligament (MCL) can lead to excessive release, as can traditional pie-crusting of the superficial MCL using a blade. We performed selective and sequential medial release using the pie-crusting method with multiple needle punctures and investigated the effectiveness and safety of the technique during primary TKA. There were no complications, that is, no hematoma formation, conversion to a constrained implant, or late instability. The technique was safe, reproducible, and effective in treating severe varus deformity during primary TKA.
Creator: Albert Lin, MD
Duration: 3:14
Ultrasound examination of the shoulder, including placement of the ultrasound probe for optimal visualization of the shoulder anatomy.
Creator: Kathleen Rickert, MD
Duration: 00:32
The video shows the modified Broström technique of direct, anatomic repair to manage chronic lateral ankle instability in the immature athlete.
Creator: Michael T. Archdeacon, MD
Duration: 12:01
The modified Stoppa, or anterior intrapelvic, approach to the acetabulum provides straightforward anatomic exposure that can be used for direct access to the pelvic brim, posterior column of the acetabulum, and the quadrilateral surface. The improved visualization provided by this approach facilitates fracture reduction and stabilization. This approach does not require surgical dissection of the inguinal canal and femoral neurovascular bundle. A traditional lateral window may be incorporated to facilitate reduction and stabilization of anterior column fracture. This anterior intrapelvic approach is contraindicated in fractures with posterior-only patterns that exit below the ischial spine.
Creator: Davide Blonna, MD
Duration: 0:27
Our technique was developed to use the advantages of traditional percutaneous pinning (eg, temporary fixation, preservation of the soft tissues, better cosmesis) and improve its limitations, in particular, the weak fixation in osteoporotic bone. The main modifications are the use of long threaded pins to achieve purchase in good-quality bone beneath the articular surface of the humeral head and in the lateral cortex of the metaphysis, which helps to obtain strong bicortical fixation, as well as the use of a dedicated external fixator to further increase pin stability.
Creator: Mohamed Kenawey, MD
Duration: 0:24
This video presents three modifications of the surgical technique for combined glenoid anteversion osteotomy and tendon transfer for the management of brachial plexus birth palsy.
Creator: Cesare Faldini, MD
Duration: 0:28
The video shows the surgical correction of a double major scoliosis deformity in a 14-year-old girl with normal kyphosis and type C lumbar modifier. Double major curve involves a major thoracic structural curve and a minor thoracolumbar or lumbar structural curve. The axial rotation of the vertebrae and ribs induce the rib hump deformity in the thoracic region and thoracolumbar passage, which requires particular attention at the time of vertebral rotation. To correct the deformity in all three planes, the surgical correction is performed by applying simultaneous dual-rod and direct vertebral rotation.
Creator: Matthew T. Burrus, MD
Duration: 0:27
For severe trochlear dysplasia with patellar instability, a sulcus-deepening trochleoplasty is a reliable surgery to correct a patient’s abnormal distal femoral morphology. In previous studies, redislocation rates after this procedure have been universally low. In this video, the surgical technique is presented in detail, and one center’s experience with this procedure is examined.
Creator: Cesare Faldini, MD
Duration: 0:26
Retrospective evaluation of 13 patients (mean age, 34.8 years) treated with tibialis posterior tendon transfer to manage foot drop deformity secondary to insufficiency of the muscles of the anterior compartment of the leg. The tibialis posterior tendon was transferred onto the intermediate or lateral cuneiform, then pulled out through a transosseous tunnel and fixed at the plantar surface. Seven patients underwent Achilles tendon lengthening before tibialis posterior transfer. Results were excellent in five patients, good in five, fair in two, and poor in one based on the Stanmore scale (0 to 100). No major complications occurred.
Creator: Braden E. Hartline, MD
Duration: 0:31
This video shows a technique of using a fixed-angle blade plate to treat a proximal femur fracture.
Creator: Thanapong Waitayawinyu, MD
Duration: 2:05
Demonstrates a vascularized bone graft for scaphoid nonunion.
Creator: Thanapong Waitayawinyu, MD
Duration: 1:59
Demonstrates an alternative to the palmar approach for scaphoid nonunion.
Creator: Justin Greisberg, MD
Duration: 0:16
The authors demonstrate the restoration of subtalar alignment in hindfoot arthrodesis.
Creator: Thanapong Waitayawinyu, MD
Duration: 1:38
Demonstrates the palmar approach for scaphoid nonunion.
Creator: Jeffrey King, MD
Duration: 18:23
Although initially developed for fixation of an anterior cruciate ligament graft, EndoButton (Acufex Microsurgical, Mansfield, MA) repair of distal biceps tendon ruptures provides strong fixation to allow early motion, lessens technical difficulty in securing fixation, and utilizes a bone socket to maximize tendon healing.
Creator: Peter G. Whang, MD
Duration: 1:55
Demonstrates a technique for posterior instrumentation in the treatment of thoracolumbar burst fracture, including positioning and approach, pedicle screw/hook insertion, rod contouring and insertion, distraction/ligamentotaxis reduction, final bone grafting, final tightening and cross linking, and closure.
Creator: Ronald A. Lehman, Jr, MD, MAJ, MC, USA
Duration: 22:31
Cervical laminaplasty is an extensile approach used to decompress the spinal cord in patients with myelopathy. Laminaplasty allows for indirect decompression of the spinal cord by opening the lamina on one side, thereby creating a "hinge" joint that allows the spinal cord to float dorsally.
Creator: Joseph P. Burns, MD
Duration: 21:20
Arthroscopic repair is used as a first-line technique for repairing even large and massive rotator cuff tears. An all-arthroscopic technique is less damaging to the overlying deltoid muscle than are open or mini-open techniques. All-arthroscopic technique provides greater versatility in terms of characterizing, accessing, mobilizing, and fixing the torn rotator cuff tendon. Arthroscopic repair allows complete evaluation of the intra-articular and bursal anatomy while causing minimal morbidity in terms of postoperative pain and scarring. We report our stepwise technique for arthroscopic repair of full-thickness rotator cuff tears (using triple-loaded suture anchors) and key steps for maximizing efficiency and reproducibility.
Creator: Kern Singh, MD
Duration: 2:17
Demonstrates laminoplasty for lumbar spinal stenosis, including exposure, and hemilaminectomy/decompression.
Creator: Thomas A. DeCoster, MD
Duration: 3:21
Demonstrates the preparation of antibiotic-impregnated beads in the preparation and use of antibiotic-impregnated beads for orthopaedic infections.
Creator: Craig I. Title, MD
Duration: 4:07
Morton neuroma, or interdigital neuritis, is a compression neuropathy with associated perineural fibrosis that is caused by entrapment of the interdigital nerve near the distal edge of the transverse intermetatarsal ligament. The second and third interdigital nerves in the forefoot are most commonly involved. Surgical treatment should be reserved for select patients with a clear diagnosis. Surgery is done to decompress the entrapped interdigital nerve by transecting the intermetatarsal ligament, releasing or resecting the interdigital nerve itself, and/or releasing any nerve branches causing tethering, thereby allowing the nerve to move more proximally away from the weight-bearing portion of the forefoot.
Creator: Mark E. Easley, MD
Duration: 33:12
Several procedures of varying complexity have been used to manage symptomatic osteochondral lesions of the talus. Arthroscopic procedures rely on marrow stimulation to fill the osteochondral defect with fibrocartilage that is less durable than the native hyaline cartilage. These relatively simple and inexpensive procedures introduce no donor site morbidity and do not preclude subsequent open reconstructive salvage. Open reconstruction, which fills the defect with near-normal hyaline cartilage, is technically demanding, requires extensive exposure, and carries a risk of donor site morbidity or disease transmission. Open techniques are generally indicated for larger lesions or as secondary procedures after failed arthroscopic management.
Creator: Eric T. Ricchetti, MD
Duration: 3:57
Locked plating for proximal humerus fractures is becoming more common; precise knowledge of and experience with the surgical technique is required to maximize clinical outcomes.
Creator: Ashok Sunil Gavaskar Kumaresan, MS
Duration: 0:24
Surgical treatment of femoral head fractures is recommended in cases of incongruent or unstable hip joint after closed reduction. Safe surgical dislocation provides circumferential exposure of the femoral head and acetabulum to address fractures and labral injuries without additional risk of osteonecrosis of the femoral head. Sound knowledge of the vascular supply to the femoral head, meticulous posterior soft-tissue dissection, and a precise osteotomy technique are imperative to avoid iatrogenic injury to the femoral head blood supply. Explanation of the anatomic basis, key landmarks, and techniques in safe surgical dislocation for a Pipkin type II fracture-dislocation.
Creator: Rachel M. Frank, MD
Duration: 1:42
Creation of the 7 o’clock posterolateral accessory portal with serial dilators. The technique is shown on a right shoulder in the lateral decubitus position. It is used in the management of posterior glenohumeral instability.
Creator: Rachel M. Frank, MD
Duration: 1:04
Diagnostic arthroscopy of a left shoulder in the lateral decubitus position seen from the standard anterior portal. Preparation of the posterior labral-glenoid interface with an arthroscopic elevator.
Creator: Robert Probe, MD
Duration: 1:19
Demonstrates closed reduction and percutaneous pinning for femoral neck fractures, including positioning and reduction, surgical exposure, guidewire placment, screw placement, and screw position confirmation.
Creator: Christopher S. Ahmad, MD
Duration: 0:21
Demonstrates anatomic interference screw fixation in the treatment of elbow valgus instability in throwing athletes, including incision, graft harvest and preparation, approach, ulnar and humeral tunnel creation, ulnar fixation, humeral fixation, and an alternative humeral fixation technique (docking).
Creator: Robert V. Cantu, MD
Duration: 0:53
Demonstrates the use of locking plates in fracture care, including setup and exposure, plate insertion and provisional fixation, confirmation of placement and provisional reduction, and screw insertion and final fixation.
Creator: Brian Su, MD
Duration: 0:46
Demonstrates arthroscopic bankart repair for glenohumeral instability, including approach, glenoid preparation, Bankart repair, and confirmation of repair and closure.
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Demonstrates open reduction and internal fixation of distal humerus fractures, including preoperative planning, exposure, reduction and provisional fixation, definitive fixation, closure, and verification.
Creator: Joshua M. Abzug, MD
Duration: 0:15
Evaluation of active and passive range of motion via the tenodesis grasp and release allows surgeons to assess the integrity of the tendons.
Creator: Asheesh Bedi, MD
Duration: 0:10
The patient is positioned supine, with the hip flexed to 45 degrees and the knee flexed to 90 degrees and is instructed to slide the foot down the table.
Creator: Pooya Hosseinzadeh, MD
Duration: 0:19
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Duration: 0:15
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