FH Orthopedics

The ARROW system is a set of solutions that make it possible for surgeons to choose or review their choice of shoulder prosthesis in the peri-operative period.

During SOFCOT 2003, the ARROW system was the innovation of the conference. It was one of the first proposals made to surgeons in terms of universality. Since then, many of our competitors have taken their inspiration from this solution.

The unique set of instruments, used for implanting the various different prostheses, is a major asset.

Indications

The indications for shoulder prostheses concern emergency surgery (complex fracture of the upper end of the humerus) and non emergency surgery (arthrosis or glenoid wear, arthritis, sequellae from fractures).

The state of the rotator cuff, the age of the patient and condition of the bone stock all play a determining role in the type of prosthesis that can be used.

Unprogrammed surgery

A fracture with 3 or 4 fragments, in an elderly subject though under the age of 70 and depending on the condition of the rotator cuff : a simple humeral prosthesis can be chosen, reducing the tuberosities anatomically.
With the same fracture but in an older patient, comminution of the tuberosities and sufficient glenoid bone stock, a reverse prosthesis could be chosen.

Programmed surgery

• Centred glenoid wear, glenohumeral arthrosis with the rotator cuff in good condition. A glenoid in good condition and with the anatomical form respected : the choice will tend towards a simple humeral prosthesis.
  

• Centred glenoid wear, with a glenoid in poor condition and sufficient bone stock: the choice will tend towards a total anatomical prosthesis with a glenoid implant either with or without cement.

• Excentred glenoid wear, glenohumeral arthrosis, with the rotator cuff in poor condition. If the bone stock of the glenoid cannot support an implant or glenoid graft, only the simple humeral prosthesis is possible.

• Excentred glenoid wear, but the humeral head has built its own neo-articulation. The joint is mobile: the simple humeral prosthesis is a satisfactory solution.

• Excentred glenoid wear, sufficient bone stock : the reverse prosthesis is recommended

• Pseudo-paralytic shoulder with active anterior elevation < 60°: the reverse prosthesis is recommended.

• Humeral head necrosis :
• If the glenoid is in good condition, the simple humeral prosthesis is a solution that can be envisaged;
• If the glenoid is damaged, this is an indication for a total anatomical prosthesis.
  

• With fracture sequellae, and depending on the age of the patient and condition of the rotator cuff, a simple or reverse humeral prosthesis are possible

• Glenoid fracture or reconstruction of the glenoid, if the rotator cuff is in good condition, it is possible to use a metal-back anatomical prosthesis.
  

The concept

The ARROW system was the first universal system for shoulder arthroplasty.
It allows surgeons, whether they are experienced or not, to implant a reverse or anatomical prosthesis using the same set of instruments.

Furthermore, with the same stem (cemented or not), surgeons can implant either a simple humeral prosthesis, an anatomical prosthesis with a 4-peg glenoid (to be cemented) or metal-back without cement, or, finally, a reverse prosthesis.

Thanks to the universal instrument set, in the peri-operative period surgeons can review their choices for a variety of reasons.
They can also, after a certain amount of experience and depending on the condition of the patient, and without changing stem :

• Transform a simple humeral prosthesis into a reverse prosthesis without removing the stem.
• Transform an anatomical prosthesis with metal-back glenoid into a reverse prosthesis and a metal-back glenoid implant.

The design o f the reverse prosthesis, which is less medialised than any of the other implants on the market, has allowed us to observe that there are no notches on the scapular body.

The unique instrument set, for both types of prostheses, is simple, and makes it possible to use easily reproducible techniques.

Product characteristics

Anatomical prosthesis

Stems : 4 sizes:

• Diameter 8 mm, length 120 ;
  
• Diameter 10 mm, length 125 ;
  
• Diameter 12 mm, length 130 ;
  
• Diameter 14 mm, length 135 ;

Material : Titanium
1 angle of 135°

Set of centred and excentred heads of different diameters and heights
See the sizes available on the ARROW documentation (right)
Material : Stainless steel

4-peg glenoid
3 sizes (44, 46, 48) + 1 optional (50)
Material: UHMWPE (Ultra High Molecular Weight Polyethylene)

Metal back insert with centring brace and anterior-posterior lug
3 sizes (44, 46, 48) +1 optional (50)
Material : Titanium coated with HAP (Hydroxyapatite)

Glenoid insert
3 sizes (44, 46, 48)+ 1 optional (50)
Material : UHMWPE

Reverse prosthesis

Stems : 4 sizes

• Diameter: 8 mm, length 120
• Diameter 10 mm, length 125
• Diameter 12 mm, length 130
• Diameter 14 mm, length 135
  

Material : Titanium
1 angle of 135°

Humeral insert :
3 diameters ( 36, 39, 42 )
3 heights ( 00:+05:+10)
Material: UHMWPE mounted on metal-back, impacted with a Morse cone.

Metal-back insert :
3 sizes (44, 46, 48) +1 optional (50)
Material : Titanium coated with HAP

Glenosphere :
3 sizes ( 36, 39, 42)
Material : Stainless steel

Universal instrument set: anatomical & reversed

4 trays