Chandigarh
19 January 2018
DIVYA AZAD
Shoulder replacements are becoming more popular with Reverse shoulder replacements being the state of the art. Keeping in view the same, Fortis Mohali has associated with UK based shoulder surgery consultant, Dr. Vinod Kathuria to visit the hospital every month to provide consultation and carry out shoulder joint related procedures.
The procedures offered by Dr. Vinod include shoulder replacements such Hemi arthroplasty, resurfacing arthroplasty, stemless shoulder replacements, reverse shoulder replacements and revision shoulder replacements; arthroscopic surgery such as Rotator cuff repairs, Stabilisation procedures including labral repairs, inferior capsular shift and SLAP repairs, Subacromial decompression and excision of AC joint, and Supra scapular nerve ablation. Reconstructive surgery such as AC joint stabilisation, latissimus dorsi transfer, corrective osteotomies and complex shoulder trauma surgery shall also be catered to.
Reminded of one of the more challenging cases for total shoulder replacement Dr. Kathuria said, “The patient was a 68 years old man with infective loosening and bone loss in glenoid. He underwent Stage one open washout/ debridement and IV antibiotics in the community for 6 weeks. He then was confirmed to have three clear aspirates and normal inflammatory markers. The second stage was removal of the prostheses and the cerclage wires. Rotor cuff was torn and of poor quality. He therefore underwent revision to reverse shoulder replacement. This type of TSR bypasses the torn tendons and engages the deltoid to do compensatory motion.”
“The patient is now 12 months post op and remains infection/pain free and has near 90% of abduction and forward flexion. External oration is full and internal motion 60% as compared to the other side”, he further added.
Talking about a second patient Dr. Kathuria added, “The patient is a 76-year-old female who now has 75% rotation of her shoulders, full abduction, full forward flexion and no pain. She was originally presented with painful shoulders and very little movement. She was found to have irreparable rotator cuff tendons and high riding humeral heads and osteoarthritis. She underwent reverse replacements bilaterally.
He explained about the unique procedure involved in reverse polarity shoulder replacement that involves changing the mechanics of shoulder joint. Normally the socket is at the top and ball at the bottom. The joint being held together by a cuff of muscle at the top like a hood. When the cuff/hood is torn, the ball escapes upwards and starts to touch the bone at the top causing pain and loss of function
He said, “This causes pain and limitation of movements to point that the patient can just about shrug the shoulders. The delta reverse shoulder system flips the ball and the socket so that the socket is at the bottom and that prevents the arm/humerus from riding up and causing pain. it also shifts the center of rotation outwards enabling the deltoid to provide the lever function and thereby movements Doing a standard shoulder replacements in these cases would be failure right from the start.”
Dr. Vinod Kathuria specializes in this concept of shoulder replacements and has a large series of patients with reverse shoulder replacements for arthritis and also for serious non-salvageable proximal humeral trauma.
He is a leading authority on shoulder replacements He also chaired an international meeting in South Korea on reverse shoulder replacements Biomechanics and its outcomes in the year 2016.
