Synthes Delta Xtend User manual

SURGICAL TECHNIQUE
This publication is not intended for distribution in the USA.
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DELTA XTEND™ REVERSE SHOULDER SYSTEM
KEY SURGICAL STEPS
Superior-lateral
Approach
Humeral Surgical Steps
3. Proximal reaming guide
positioning
1. Approach 2. Humeral head resection
Modular Implant
Cementless Technique
Monobloc Implant
Cemented Technique
1. Approach
Delto-pectoral
Approach
2. Humeral head resection
1. Choice of optimal metaglene
positioning
2. Wire guided glenoid reaming 3. Metaglene central peg drilling
Glenoid Surgical Steps

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Modular Implant
Cementless Technique
Monobloc Implant
Cemented Technique
4. Determination of the epiphysis size 5. Proximal humeral
reaming
6. Final implant insertion 7. Cup impaction
4. Determination of the epiphysis size and
eccentricity
5. Proximal humeral
reaming
6. Diaphyseal broaching
and angulation
measurements
7. Epiphysis/diaphysis
assembly
8. Final implant insertion 9. Cup impaction
Standard Option Eccentric Option
4. Metaglene impaction 5. Inferior and superior locking
screw insertion
6. Anterior and posterior spherical
head screw insertion
7. Glenosphere implantation

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Cuff Tear Arthropathy (CTA) was described by Charles Neer in 19831and has historically been seen as a significant surgical
challenge.
Non-constrained total or hemi shoulder arthroplasties have poor clinical outcomes for such indications. The majority of
constrained and semi-constrained prostheses developed in the 70’s – 80’s for CTA (in particular all reversed ball and socket
designs) remained purely experimental due to poor range of motion, instability and a high rate of glenoid loosening.2,3
In 1985, Paul Grammont (Dijon University Hospital - France) designed the first semi-constrained reverse concept that met
the challenges inherent in cuff tear arthropathy cases:3Known today as the DePuy DELTA CTA™ Reverse Shoulder, this
shoulder prosthesis is a leading treatment for shoulder cuff tear arthropathy5, with more than 25 years of heritage3,4.5 and
40,0006cases performed all over the world.
Based on the experience of the DELTA CTA Reverse Shoulder, the next generation of implant evolved; the DePuy DELTA
XTEND Reverse Shoulder System. It has been designed using the latest scientific, engineering and clinical knowledge to
maximise the clinical outcomes and enhance long-term survivorship in CTA cases by:
•Respecting the three design features that differentiated the DELTA CTA Reverse Shoulder from previous
designs:
 3,4
 3,4
 5,7
•Reducing the risk of scapular neck erosion while maximising the shoulder range of motion:
 
system.8,9,19
 10
•Preserving bone for earlier intervention and faster recovery with:
 15,16
 ®anatomic shoulder history.
 
 
Based on the success of the DELTA CTA Reverse Shoulder, the DELTA XTEND Reverse Shoulder System is the next step
forward for appropriate management of patients with a grossly deficient rotator cuff joint with severe arthropathy. Its
20 The

that helps you treat your patient more effectively.
Dr Didier Capon
France
Dr David Collins
USA
Prof Anders Ekelund
Sweden
Dr Laurent Lafosse
France
Prof Lieven
De Wilde
Belgium
Dr Cécile Nérot
France
Dr Ludwig Seebauer
Germany
Dr Michael Wirth
USA
The DELTA XTEND Reverse Shoulder System Surgeon Design Team
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CONTENTS
Design Rationale .........................................................................................8
DELTA XTEND Reverse Shoulder System Features .......................................................8
Surgical Technique ...................................................................................10
Pre-operative Templating and Patient Positioning.....................................................10
Surgical Approach ...................................................................................................11
Intramedullary Canal Preparation.............................................................................13
Humeral Head Resection .........................................................................................14
Exposing the Glenoid ..............................................................................................18
Positioning the Metaglene.......................................................................................19
Reaming the Glenoid...............................................................................................22
Drilling the Central Hole ..........................................................................................23
Metaglene Implantation ..........................................................................................24
Inferior and Superior Metaglene Screw Placement ...................................................25
Anterior and Posterior Metaglene Screw Placement.................................................28
Placement of the Proximal Humeral Reaming Guide.................................................30
Cementless Modular Humeral Implants
Proximal Humeral Reaming ..................................................................................31
Distal Humeral Broaching.....................................................................................33
Humeral Trial Stem and Epiphysis Insertion ...........................................................34
Cemented Monobloc Humeral Implants
Proximal Humeral Reaming ..................................................................................36
Humeral Trial Implant Insertion.............................................................................37
Glenosphere Trial Placement....................................................................................38
Cup Trials and Trial Reduction ..................................................................................39

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 ................................................................40
Definitive Glenosphere Fixation................................................................................41
Cementless Modular Humeral Implants
Definitive Humeral Implant Insertion ....................................................................44
Cemented Monobloc Humeral Implants
Definitive Humeral Implant Insertion ....................................................................46
Cases of Proximal Humeral Bone Loss......................................................................48
Revision to Hemi-Arthroplasty..................................................................................50
Closure....................................................................................................................51
Post-operative Management....................................................................................51
Ordering Information................................................................................52
Implants ..................................................................................................................52
Instrumentation.......................................................................................................54

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Cemented Monobloc Stem
7Polished Cobalt Chromium alloy for increased mechanical
strength and optimised cemented fixation14
8Standard and long monobloc stems with suture hole
fins and proximal height laser marking on the trial stem
for use in proximal bone loss cases
9Thin proximal area for bone preservation
10 3
Cementless Modular Stem
1Hydroxyapatite (HA) coated titanium alloy for
optimal cementless fixation11,12
2Proximal filling stem design based on the
anatomic DePuy GLOBAL design - positioned
in anatomic version for optimal press-fit
fixation12
Modular Epiphysis
3Centred and eccentric options for bone preservation
and optimal press-fit fixation
4
for increased internal rotation13
53
6Reduced diameter for bone preservation
DELTA XTEND REVERSE SHOULDER SYSTEM FEATURES
The DELTA XTEND Reverse Shoulder System is a total semi-constrained shoulder arthroplasty that reverses the normal
biomechanics between the scapular and humeral components. It moves the gleno-humeral joint centre of rotation
medially and inferiorly, increasing the deltoid lever arm and the deltoid tension. This allows the muscles of the deltoid
group to compensate for rotator cuff deficiency.5,7 The DELTA XTEND Reverse Shoulder System is comprised of two
humeral stem types, providing the choice of press-fit or cemented fixation. The glenoid component is cementless
with 4 screws as primary fixation and HA coating for secondary fixation.11,12 Each design feature has been defined
to accelerate recovery, optimise function and maximise survivorship for the CTA patient treated by reverse shoulder
arthroplasty.

11
12
15
16
13
9
8
14 ±10˚
±10˚
Polyethylene Humeral Cups
11 High mobility option for maximised range
of motion & reduced risk of scapular
erosion10,15
12 Three cup thicknesses to balance soft tissue
for optimal deltoid tension based on clinical
heritage5
DELTA XTEND CTA Heads
 
 
 
Glenoid Component
13 Increased glenosphere diameter (38 and
42 mm) and eccentric option for improved
stability, maximised range of motion and
reduced risk of scapular erosion9
14 Centre of rotation on glenoid surface for high
resistance to loosening shear forces3,15
15 Locking cannulated screws with adjustable
angulation to enhance metaglene primary
fixation and maximise resistance to loosening
shear forces3,15
16 Curved back and smaller diameter metaglene,
for bone preservation and low positioning
on the glenoid to reduce risk of scapular
bone erosion15,16

Figure 3
Figure 2
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10
Pre-operative Templating
An initial assessment of the glenoid should be carried out
using radiographic and CT imaging to determine whether
the patient is suitable for treatment. The size of the
glenoid vault should be assessed to ensure that all four
metaglene screws can be placed within glenoid bone.
Pre-operative planning should also be carried out using AP
and lateral shoulder radiographs of known magnification
and the available template to help the surgeon determine
the size and alignment of the implant (Figure 1). The final
decision should be taken in the operating room, during
surgery.
Patient Positioning
The patient should be in the beach chair position, with the
affected arm completely free (Figures 2 and 3).
PRE-OPERATIVE TEMPLATING & PATIENT POSITIONING
Figure 1