CT / quantify bone loss
X match 4 units
Cell saver
Anaesthetic review
Bone graft (cortical, cancellous)
Component removal gear
- extraction gear for femur / liners
- cement removers for cemented femur
- curved osteotomes for cemented cup
- X-plant for uncemented cup
Revision long stem femoral implants
Revision acetabular implants including cages
Aim
Reconstruct anterolateral bundle
Graft Options
A. 4 strand hamstring autograft
B. Achilles Allograft
- bony block for femur (9 x 20 mm)
- tubularise tendon to fit through 9 or 10 mm tunnel
- don't cut tendon short
Vumedi Dr Bruce Levy Cadaveric video
Graft Preparation
Defrost
- in 2 litres normal saline
- can add vancomycin powder
Choose which part of graft to use
- usually central third
- can take either side
- try to leave sufficient graft in case of disasters
- i.e. dropping or rupturing graft
Harvest graft
Advantage
- endobutton simple yet strong fixation
- endobutton eliminates problem if blow out back wall
Placing patient into a strong magnetic field
- 30 000 x stronger than the earth's magnetic field
Stronger magnets, better images, shorter times
- 1.5 Tesla
- 3 Telsa
The nuclei of elements with odd numbers of protons line up
- i.e. hydrogen atoms
- hydrogen is plentiful in fat and water
A radiofrequency is then applied, exciting the protons
Position
- beach chair / lateral
- water pump, adrenaline in bags
- block pre-op useful as easier to control BP
- often inject the SAD with combination of LA with A prior to scope
Posterior portal
- 2 cm inferior, 1 cm medial
- soft spot between IS and Tm
Enter subacromial space
- sweep to clear adhesion
- saline on pump at 30 - 40 - 50
Described by Neer / modified by Rockwood
1. Anterior acromioplasty
- resect anterior acromion back to ACJ
- prevent impingement in flexion
2. Resect anteroinferior acromion
Position
- beach chair
- mark anatomy
- limb draped free
Compare both shoulders
- ROM
- anterior and posterior draw
- load and shift
- sulcus sign
1. Establish portals
A. Posterior portal for viewing
B. Anterior portal
- need to keep low and away from biceps, otherwise difficult to get around biceps
- for suture passage, if in combination with bankart repair often use AI portal instead of AS