ARROW universal shoulder prosthesis

When it was introduced in 2003, the ARROW shoulder system was one of the first universal systems for shoulder arthroplasty.

It allows surgeons to implant a reverse or anatomical prosthesis with the same set of instruments.

The universal stem can be used with and without cement for hemiarthroplasty, total anatomical (4-peg cemented glenoid base or cementless metal-back base) or reverse shoulder arthroplasty.

The instrumentation set consists of four instrument baskets.

Depending on the patient’s needs, the surgeon may have to revise the prosthesis.

The surgeon can keep the current humeral stem and then:
– convert a hemiarthroplasty into a reverse shoulder or
– convert a total shoulder into a reverse shoulder

The surgeon can also keep the humeral stem and metal-back glenoid base and then
– convert a total shoulder with metal-back glenoid base into a reverse shoulder

The single instrumentation set for both types of implants is simple and contributes to the reproducibility of these techniques.

The indications for shoulder arthroplasty are scheduled surgery (osteoarthritis or glenohumeral OA, rheumatoid arthritis, fracture sequelae) and trauma surgery (complex proximal humerus fractures).

The patient’s age, condition of the rotator cuff and bone stock determine which implant is needed.

ANATOMICAL:

Stems / 4 sizes / 135° neck-shaft angle:
– 8 mm diameter, 120 mm length
– 10 mm diameter 125 mm length
– 12 mm diameter 130 mm length
– 14 mm diameter 135 mm length
– material: titanium

Centred and off-centred heads:
– see ARROW documentation for sizes
– material: stainless steel

Cemented glenoid:
– glenoid with 4 pegs
– 3 sizes (44, 46, 48) + 1 optional (50)
– material: UHMWPE (ultra-high molecular weight polyethylene)

Glenoid insert:
– 3 sizes (44, 46, 48)
– material: UHMWPE

Metal-back glenoid base with keel and anteroposterior tab:
– 5 sizes (44S, 44, 44R, 46, 48)
– material: hydroxyapatite (HA) coated titanium

REVERSE:

Stems / 4 sizes / 135° neck-shaft angle:
– 8 mm diameter, 120 mm length
– 10 mm diameter, 125 mm length
– 12 mm diameter, 130 mm length
– 14 mm diameter, 135 mm length
– material: titanium

Standard humeral insert:
– 3 diameters (36, 39, 42)
– 3 heights (00, +05, +10)
– material: UHMWPE set on metal-back base, impacted by Morse taper

Metal-back glenoid base with keel and anteroposterior tab:
– 5 sizes (44S, 44, 44R, 46, 48)
– material: hydroxyapatite (HA) coated titanium

Glenosphere:
– 3 sizes (36, 39, 42)
– material: stainless steel

UNIVERSAL INSTRUMENTATION: ANATOMICAL AND REVERSE

– 4 baskets

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2. Valenti, P., et al., How to manage an unstable reverse total shoulder arthroplasty : retrospective review of 25 cases? . PISC 2017 – Current concepts on shoulder arthroplasty, 2017. 2: p. 138-142.
3. Kany, J., Instablity related to inadequate lentgth of the humerus. PISC 2017 – Current concepts on shoulder arthroplasty, 2017: p. p. 144-147.
4. Castagna, A., et al., Metal back glenoid implant en evidance based medicine update. PISC 2017 – Current concepts on shoulder arthroplasty, 2017: p. p. 60-63.
5. Kany, J., et al., The main cause of instability after unconstrained shoulder prosthesis is soft tissue deficiency. J Shoulder Elbow Surg, 2017.
6. Katz, D., et al., Regarding “Metal-backed glenoid implant with polyethylene insert is not a viable long-term therapeutic option”. J Shoulder Elbow Surg, 2016. 25(12): p. e394-e395.
7. Katz, D., et al., Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up. Int Orthop, 2015.
8. Valenti, P., et al., Uncemented metal-back glenoid component in revision of aseptic glenoid loosening: a prospective study of 10 cases with a minimum follow-up of 2 years. Arch Orthop Trauma Surg, 2014.
9. Kany, J., et al., A convertible shoulder system: is it useful in total shoulder arthroplasty revisions? International Orthopaedics, 2014: p. 1-6.
10. Valenti, P., et al., Results of 30 reverse shoulder prostheses for revision of failed hemi- or total shoulder arthroplasty. European Journal of Orthopaedic Surgery & Traumatology, 2013.
11. Katz, D., et al., New design of a cementless glenoid component in unconstrained shoulder arthroplasty: a prospective medium-term analysis of 143 cases. Eur J Orthop Surg Traumatol, 2013. 23(1): p. 27-34.
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13. Kany, J., Glenoid or not glenoid component in primary osteoarthritis. Eur J Orthop Surg Traumatol, 2013. 23(4): p. 387-93.
14. Kany, J., Classifications of glenoid dysplasia, glenoid bone loss and glenoid loosening: a review of the literature. Eur J Orthop Surg Traumatol, 2013. 23(3): p. 301-10.
15. Katz, D., et al., The case for the metal-backed glenoid design in total anatomical shoulder arthroplasty. European Journal of Orthopaedic Surgery & Traumatology, 2012. 22(1): p. 9-16.
16. Valenti, P., et al., Do less medialized reverse shoulder prostheses increase motion and reduce notching? Clin Orthop Relat Res, 2011. 469(9): p. 2550-7.
17. Valenti, P., et al., Lateralization in the design of the reverse shoulder arthroplsty is it dangerou? Is it useful?, in Shoulder Concept 2010 The Glenoid, S. MEDICAL, Editor. 2010. p. 353- 364.
18. Kalouche, I., et al., Reverse shoulder arthroplasty: does reduced medialisation improve radiological and clinical results? Acta Orthop Belg, 2009. 75(2): p. 158-66.
19. Valenti, P., et al., The Reverse Shoulder Prosthesis-Surgical Technique. Techniques in Hand & Upper Extremity Surgery, 2008. 12(1): p. 46-55 10.1097/BTH.0b013e3181572b14.
20. Valenti, P., D. Katz, and P. Sauzieres, Résultats d’une prothèse d’épaule inversée latéralisée: Results of a lateralized reversed shoulder arthroplasty, in Prothèses d’épaule. État actuel, P. Boileau and G. Walch, Editors. 2008, Elsevier Masson: Paris. p. 169-180.
21. O’Toole, G., et al., A history of the reverse shoulder prosthesis. International Journal of Shoulder Surgery, 2007. 1(4): p. 108.