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Remplissage james wilson
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Transcript of Remplissage james wilson
“I have a simple philosophy: Fill what’s empty. Empty what’s full. Scratch where it itches.”
Alice Roosevelt Longworth
Remplissage
James Wilson
ST8 Trainee T&OUpper Limb Fellow
Wrightington Hospital
• Remplissage -
• filling
• filling in
• filling out
• padding
• charging
Definition
• Humeral head defects commonly associated with dislocation
• Hill-Sachs lesion = impression fracture postero superior (>80%)
• Large defect reduces rotational arc length
• Engagement leads to recurrent dislocation
Background
Hill HA Sachs MD . The grooved defect of the humeral head. A frequently unrecognized complication of dislocations of the shoulder joint. Radiology. 1940;35:690-700.
• Published by Purchase et.al as a Technical Note in Arthroscopy
• Posterior portal for initial assessment
• Antero-Superior portal then used for viewing
• Hill-Sachs and capsule freshened
• Bankart repair prepared
Description
7
• September 2014 - Systematic review in Arthroscopy
• Looked at studies reporting outcomes for:
• Remplissage
• Weber osteotomy
• Allograft reconstruction
• Arthroplasty
What is the evidence
• Remplissage 29.5 months
• Weber osteotomy 108 months
• Allograft reconstruction 61.3 months
• Arthroplasty 51.4 months
Follow up
• Remplissage 0.9% 2/212
• Weber osteotomy 29% 53/184
• Allograft reconstruction 74% 17/23
• Arthroplasty 19% 20/104
Complications
Outcomes
Constant Rowe score for instability ASES
Remplissage 94.6 (3) 89.4 (9) 89.1 (5)
Weber Osteotomy 79 (1)
Allograft 76.2 (3)
Arthroplasty 58.2 (4) 71.4 (1) 65.8 (2)
• Dislocation or subluxation
• Remplissage 6.3% 21/333
• Weber osteotomy 5.6%
• Allograft reconstruction 0%
• Arthroplasty 14%
Recurrence of instability
• Remplissage did not significantly affect ROM
• Studies comparing Bankart to Bankart plus remplissage - no significant difference.
Range of motion
• Franceschi • Comparative study
• Historical controls
• Different surgeons
• However, groups well matched for age and pathology • Average D/R index 30%
• Good scores, no recurrence and good ROM in the R&B group
More detail
• Cohort study designed to compare ROM for the two groups
• Dissimilar groups: • ISIS 5 or 6 vs ISIS < 5
• Outcomes similar
• ROM no difference
• One recurrence per group
Nourissat et al
• Stephen Burkhart
• If D/R index >15% (about 4mm) high rate of recurrent instability
• Minimal glenoid bone loss (<25%)
• Where arthroscopic stabilisation planned but increased stability wanted
• Not for inverted pear glenoids
• Do the Bankart first
Other opinions
Follow up