Copeland Shoulder, Biomet - ShoulderDoc.co.uk

ClosureDeltopectoral ApproachThe subscapularis is repaired using No. 1 suture material (absorbable [ PDS ]or non-absorbable) without plicating the subscapularis or with through bonesutures. The rotator interval is closed. If there is any rotator cuff deficiencythen full rotator cuff repair is made in the normal manner at this stage. Everyattempt is made to close the rotator cuff completely.The delto-pectoral interval is closed using 2 or 3 interrupted absorbablesutures.Subcutaneous fat is opposed with absorbable sutures and appropriate skinclosure undertaken with Intra-dermal continuous absorbable suture(3/0 Monocryl).Antero-superior “Mackenzie”ApproachThe subscapularis is repaired using No. 1 suture material (absorbable [ PDS ]or non-absorbable) without plicating the subscapularis or with through bonesutures. The rotator interval is closed. If there is any rotator cuff deficiencythen full rotator cuff repair is made in the normal manner at this stage. Everyattempt is made to close the rotator cuff completely.Fig. 17The deltoid is reattached to the acromion with No. 1 absorbable sutures (PDS)through bone [ Fig. 17 ].The deltoid split is approximated with 2/0 absorbable suture.Subcutaneous fat is opposed with absorbable sutures and appropriate skinclosure undertaken with Intra-dermal continuous absorbable suture(3/0 Monocryl).Postoperative ManagementThe patient is placed in a sling with bodybelt and brachial block analgesia isused. Passive mobilizing is recommended for the first 48 hours and passiveassistance for five days thereafter. Active movements are then started as painallows and the sling abandoned at three weeks. A stretching and strengtheningprogram is then advised standard for all shoulder replacements.7