A breakfast session in Mumbai
Presenting at an ACASEA 2017 breakfast session in Mumbai on techniques for surgical exposure in difficult shoulder replacement cases.
What a breakfast session is
Surgical meetings run short instructional sessions before the main programme of the day begins. The format is deliberately narrow: one technical problem, a single presenter or a small panel, and an audience of surgeons who already perform the operation and want to compare how others handle a particular step. There is no attempt to cover a whole condition. The value sits in the detail, and in the discussion that follows, where surgeons describe what has and has not worked in their own hands.
Why exposure matters
Getting adequate access to the glenoid is one of the harder parts of a shoulder replacement. The socket sits deep, surrounded by the rotator cuff and close to important nerves, and if it cannot be seen properly the component cannot be positioned accurately. In a stiff shoulder, or one that has been operated on before, the difficulty increases considerably. Individual results vary.
The content drew on six months spent observing shoulder arthroplasty with experienced surgeons in the United States, Japan and France, including discussion of Gilles Walch's concepts with him directly.
What a shoulder replacement asks of the glenoid
The shoulder is a ball and socket joint in which the ball is large and the socket shallow. In an anatomic total shoulder replacement the worn surface at the top of the arm bone is replaced and the socket, called the glenoid, is resurfaced with a component. Because the glenoid is small, slightly dished and often worn unevenly by arthritis, the position and angle at which that component is set has a direct bearing on how the joint carries load afterwards. The surgeon has to be able to see the whole rim in order to judge it, which is why exposure is taught as a technique in its own right. Planning imaging, patient positioning, the choice of approach and the order in which tight soft tissues are released all contribute. Individual results vary.