At EFORT in Vienna
At the EFORT European Orthopaedic Conference in Vienna, presenting a scientific paper titled "Deltoid Reflection in Reverse Total Shoulder Arthroplasty".
What the EFORT congress is
EFORT is the European Federation of National Associations of Orthopaedics and Traumatology, the body that brings together the national orthopaedic associations of Europe. Its annual congress is one of the larger orthopaedic meetings held in Europe, with a programme covering the whole specialty in parallel subspecialty streams. Papers are submitted as abstracts and selected by review, and presenting at a congress is usually the first point at which a piece of work is put before an international audience, ahead of full publication. The purpose of that order is to have the method and the conclusions questioned by people doing the same work before the paper is finalised.
Reverse total shoulder replacement in brief
In a reverse total shoulder replacement the normal arrangement of the joint is inverted. A socket is fixed to the top of the humerus and a ball is fixed to the glenoid on the shoulder blade, which allows the deltoid muscle to raise the arm in a shoulder where the rotator cuff tendons are torn beyond repair or no longer functioning. An anatomic replacement cannot do this, because it depends on those tendons holding the ball centred in the socket. Reverse replacement is used for arthritis occurring with an irreparable cuff tear, for some fractures of the upper humerus and for revision of previous shoulder surgery. Individual results vary.
The technique
The paper describes the use of deltoid reflection to improve exposure of the shoulder during joint replacement surgery. Adequate exposure is one of the determinants of how accurately components can be positioned, which is the reason for interest in the technique. The paper reports the authors' experience rather than a comparison against other approaches.
Why exposure is studied in its own right
The glenoid sits deep, surrounded by muscle and close to nerves and vessels, and in a reverse replacement the component fixed to it must be prepared and seated accurately because its position governs the range of movement available and how load passes through the joint. What the surgeon can see and reach therefore constrains what can be achieved, and techniques that improve access are described, taught and debated in the same way as the rest of the operation. Individual results vary.