PRIMA Stem Surgical technique
Humerus Preparation
Dislocation of the humeral head Detach the subscapularis tendon at its insertion on the lesser tuberosity and medialize the tendon, dividing it from the underneath capsule. Perform an anterior-oblique capsulotomy, paying attention to avoid injury of the axillary nerve. A retractor, placed between the capsule and the tendon, can be used for protecting the nerve. With careful external rotation and extension (the humerus may be osteoporotic and osteophytes may block the rotation process), the humeral head is dislocated anteriorly. All humeral osteophytes are carefully removed from the humeral head so that the anatomic neck can be identified.
Foreward To complete the joint replacement hereby described, a power tool featuring a pin drive, Zimmer-Hudson connection and cutting saw blade is required.
Preoperative Planning
Pre-operative planning is highly recommended with the use of templates showing a 5% enlarged image of the profiles. Normally standard AP and Axial view of the shoulder joint are used; in some cases, a preoperative CT-Scan is recommended to perform a more accurate planning. Select the stem size and resection level of the humeral head, which will serve as a reference for the final implant height. The PRIMA prosthesis can be implanted with one of the usual approaches: • delto-pectoral • antero-lateral (deltoid splitting) The surgical technique described hereafter refers to the delto-pectoral approach.
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