HOMBRO DE REVERSA Biomet

Comprehensive®
Reverse Shoulder
System
Surgical Technique
Table of Contents
Patient Positioning, Surgical Incision/Exposure...................................................... 2

Humeral Stem Technique.......................................................................................... 4
Humeral Preparation
Interamedullary Resection Guide
Humeral Broaching
Calcar Planer
Humeral Stem Insertion – Press Fit Technique
Humeral Stem Insertion – Cemented Technique
Glenoid..................................................................................................................... 14
Glenoid Preparation
Baseplate Impaction
Baseplate Central Screw Selection/Insertion
Peripheral Screw Selection/Insertion
Peripheral Screw Selection/Insertion (Optional Method)
Glenosphere Selection
Glenosphere Offset
Glenosphere Assembly
Glenosphere/Taper Adaptor Offset Direction Determination
Glenosphere Orientation/Impaction
Humeral Tray and Bearing....................................................................................... 26
Humeral Tray and Bearing Preparation
Humeral Tray and Bearing Assembly
Humeral Tray/Bearing Impaction
Subscapularis Repair............................................................................................... 28
Revision Options...................................................................................................... 29
Removal of Glenosphere/Baseplate
Polyethylene Preparation
Polyethylene Removal
Central Post Removal.............................................................................................. 30
Salvage Hemi-arthroplasty..................................................................................... 30
Removal of the Humeral Tray/Bearing
Polyethylene Humeral Bearing Removal/Exchange............................................... 31
Fracture: Tuberosity Reconstruction...................................................................... 32
Proximal Humerus Fractures
Humeral Stem Sizing............................................................................................... 35
Standard Stem
Mini Stem
Micro Stem
Comprehensive Fracture System Sizing Chart
Ordering Information.............................................................................................. 37
1 | Comprehensive Reverse Shoulder System Surgical Technique
INDICATIONS CONTRAINDICATIONS
Biomet Comprehensive Reverse Shoulder products Absolute contraindications include infection, sepsis,
are indicated for use in patients whose shoulder and osteomyelitis.
joint has a grossly deficient rotator cuff with severe
arthropathy and/or previously failed shoulder joint Relative contraindications include:
replacement with a grossly deficient rotator cuff. The 1. Uncooperative patient or patient with neurologic
patient must be anatomically and structurally suited disorders who is incapable or unwilling to follow
to receive the implants and a functional deltoid muscle directions.
is necessary. 2. Osteoporosis.
The Comprehensive Reverse Shoulder is indicated 3. Metabolic disorders which may impair bone
for primary, or fracture total shoulder replacement formation.
for the relief of pain and significant disability due to 4. Osteomalacia.
gross rotator cuff deficiency. Optional use in revision:
in some medical conditions (e.g. revision when healthy 5. Distant foci of infections which may spread to the
and good bone stock exists), the surgeon may opt to implant site.
use primary implants in a revision procedure. 6. Rapid joint destruction, marked bone loss or bone
resorption apparent on roentgenogram.
Titanium glenospheres are intended for patients with
Cobalt Alloy material sensitivity. The wear of these
devices has not been tested but, based on pin on
disk testing, the wear rate is inferior to that of cobalt
alloy glenospheres. A Cobalt Alloy glenosphere is
the recommended component for reverse shoulder
arthroplasty patients without material sensitivity to
cobalt alloy.
Glenoid components with Hydroxyapatite (HA)

coating applied over the porous coating are indicated
only for uncemented biological fixation applications.
The Glenoid Baseplate components are intended for
cementless application with the addition of screw
fixation.
Interlok ® finish humeral stems are intended for

cemented use and the MacroBond® coated humeral
stems are intended for press-fit or cemented
applications. Humeral components with porous coated
surface coating are indicated for either cemented or
uncemented biological fixation applications.
Figure 1 Figure 2
Patient Positioning and Incision

Surgical Position Surgical Incision/Exposure
The arm and shoulder are prepped and draped free Utilize an extended deltopectoral anterior incision
(Figure 1). Utilize a modified beach chair position at beginning immediately above the coracoid process
about 30 to 40 degrees of flexion. and extending distally and laterally, following the
deltopectoral groove along the anterior border of the
deltoid (Figure 2). Laterally retract the deltoid muscle,
avoiding release of the deltoid from the clavicle.
The deltoid may be partially released from its distal
insertion by subperiosteal dissection.
Figure 3
Patient Positioning and Incision

(cont.)
Identify anterior structures and externally rotate Tag the subscapularis tendon with non-absorbable
the humerus. If the subscapularis is intact, make a sutures for easy identification during closure.
longitudinal incision through the tendinous portion Externally rotate and extend the humerus to expose
of the subscapularis muscle and capsule, just medial the humeral head, while protecting the axillary nerve.
to the lesser tuberosity (Figure 3). In cases of severe
Note: An optional biceps tenodesis may be
contracture, subscapularis lengthening may be
performed to improve exposure.
required.
Standard, Mini, and Micro Stem Technique
Standard Mini Micro
Figure 4 Figure 5 Figure 6
Humeral Preparation
Using the 4, 5 or 6 mm starter reamer and ratcheting Standard Stem – Using the standard length reamers,
T-handle, bore a pilot hole through the humeral head insert each reamer until the proximal portion of the
along the axis of the humeral shaft, just lateral to engraved line just above the cutting teeth is even with
the head’s articular surface and just medial to the the proximal portion of the greater tuberosity (Figure
rotator cuff attachment. Insert the humeral reamer 4).
to the depths described below for the chosen stem. Mini Stem – Using the standard length reamers, insert
Continue reaming in 1 mm increments until cortical each reamer until the large hashmark between the 3
contact is achieved. Note the reamer size for future and 4 on the reamer is even with the proximal portion
reference. of the greater tuberosity (Figure 5).
Micro Stem – Using the Micro length reamers, insert

each reamer until the engraved line just above the
cutting teeth is even with the proximal portion of the
greater tuberosity (Figure 6).
Standard/Micro Mini
Figure 7 Figure 8
Intramedullary Resection Guide

Place the resection guide boom onto the reamer shaft Standard Stem – Place the resection guide boom on
to the below described locations depending on stem the reamer shaft and slide it up until it rests against
selection. the top of the reamer, just below the sizing engraving
(Figure 7).
Note: The position of the resection guide boom
on the reamer shaft, along with the calibrated Mini Stem – Place the resection guide boom on the
reaming depth and stem choice, are directly related reamer shaft and slide it down until it rests against
to the proper resection height. However, the final the base surface of the reamer, just above the cutting
resection height should be based off the location teeth (Figure 8).
of the rotator cuff insertion (approximately 1 mm
Micro Stem – Place the resection guide boom on the
above the insertion). An ideal humeral resection is
reamer shaft and slide it up until it rests against the top
slightly above the rotator cuff insertion. This allows
of the reamer, just below the sizing engraving (Figure
for greater glenoid exposure.
7)
Note: The resection guide boom is NOT engraved

with Micro.
Standard/Micro Mini
Figure 9 Figure 10

(cont.)
Place the IM resection guide block onto the arm of the Standard and Micro Technique (Figure 9). Mini
boom in the proper orientation. For example, “right” Technique (Figure 10).
should be visible for a right shoulder.
Note: In chronic or fixed shoulders, a more

aggressive humeral resection may be made at this
point to create increased joint space for placement
of the prosthesis. If there is uncertainty regarding
the resection height, a standard resection should
still be performed with the option to resect more
bone later in the procedure.
Figure 11

(cont.)
Screw the version rod into the appropriate version Note: The thumb screw on the resection boom
hole, and align the rod with the forearm flexed at is not captured. Care should be taken when
90 degrees (Figure 11). adjusting/ tightening
Standard/Micro Mini
Figure 12 Figure 13

(cont.)
Set the correct version using the amount of external Place two threaded Steinman pins through converging
rotation of the forearm, slide the resection guide angled holes in the resection guide block and into the
against the humerus and finger tighten the thumb bone to secure the block to the bone. Standard and
screw. Micro Technique (Figure 12). Mini Technique (Figure
13).
Note: The thumb screw on the resection boom
is not captured. Care should be taken when
adjusting/ tightening.
Standard/Micro Mini
Figure 14 Figure 15

(cont.)
Completely loosen the thumb screw on the resection Standard and Micro Technique (Figure 14). Mini
guide block and reamer shaft. Rotate the resection Technique (Figure 15). Remove the reamer and guide
guide boom until the arm clears the resection block. boom.

(cont.) Humeral Broaching
Prior to making the humeral resection, the planned Select a broach that is at least 2 to 3 mm smaller
resection should be confirmed with the angel wing/ than the last reamer used and attach it to the broach
tissue probe. Place a saw blade through the cutting handle.
slot in the guide. The saw blade should be moving
when it comes in contact with the bone (Figure 16). Standard and Mini Stem – Use Mini length broaches
Resect the humeral head. Remove the Steinmann pins (Figure 17).
and the cut block. Micro Stem – Use Micro length broaches (Figure 18).
Figure 19 Figure 20
Humeral Broaching (cont.)

Insert the version rod into the same position used Note: The porous coating on the humeral stem is
during resection. Flex the forearm to 90 degrees, 0.75 mm thick on all sides (1.5 mm circumferentially),
and externally rotate the arm to be parallel with the which will cause the final implant to fit tighter than
version control rod indicating the chosen amount of the broach.
retroversion. Sequentially broach in 1 mm increments
until the broach size is equal to the size of the humeral Calcar Planer
reamer. For example, if the etching on the last reamer Use the calcar planer to refine the resected surface.
used indicated 10 mm, broach up to 10 mm (Figure 19). Attach the planer blade that most closely matches the
Tip: Advance each broach into the humerus in several diameter of the resected surface to the barrel of the
successive motions, tapping it up as well as down calcar planer. Insert the planer plunger into the female
between advancements. The broach is fully seated when taper of the broach. Begin rotation of the calcar planer
the collar on the broach handle rests on the resected before contacting the resected surface. Apply slight
surface of the humerus. Remove the broach handle, pressure and plane the resected surface (Figure 20).
leaving the last broach in place to be used as a trial. Note: The calcar planer should not be used in
Caution: If the broach feels too tight and will not seat, conjunction with the definitive implant. This could
finish broaching with next smaller size. potentially damage the reverse morse taper.
Note: An optional broach cover can be used to

protect the humerus while the glenoid is prepared.
Figure 21 Figure 22
Humeral Stem Insertion –

Press-fit Technique
Attach the broach handle to the broach/trial, and Insert the stem into the humeral canal (Figure 22)
remove it from the humeral canal. Select a humeral impacting if necessary.
stem which matches the final broach/trial used.
Assemble the humeral stem onto the humeral
stem inserter. Place the version control rod into the
appropriate version hole and align it with the forearm
flexed at 90 degrees (Figure 21).
Figure 23 Figure 24
Humeral Stem Insertion –

Cemented Technique
Attach the broach handle to the broach/trial, and Introduce the implant into the humeral canal (Figure
remove it from the humeral canal. Select a humeral 24), keeping the alignment rod in line with the forearm,
stem 2 mm smaller than the final broach/trial used. until the desired position is attained. Remove excess
Assemble the humeral stem onto the humeral stem cement.
inserter. Use a pulse lavage/suction unit to thoroughly
clean the humeral canal. Dry the canal with absorbent
gauze and inject doughy cement in a retrograde
manner, completely filling the humeral canal. Place
the version control rod into the appropriate version
hole and align it with the forearm flexed at 90 degrees
(Figure 23).
Figure 25
Glenoid
There are two baseplate options (Mini and Standard) Ideally, the Steinmann pin should be placed into the
available, each with specific instrumention. For a best possible bone stock, keeping in mind the Versa-
breakdown of these instruments, refer to the tray Dial® glenosphere can be offset up to 4.5 mm in any
layouts beginning on page 40. direction.* It may be helpful to section off the glenoid
into quadrants for ease of placement of the Steinmann
Glenoid Preparation pin, as the best bone is often located centrally.
Attach the threaded glenoid guide handle to the
*For the 36 mm standard glenosphere, the offset
glenoid sizer. Insert a 3.2 mm Steinmann pin into the
range is 1.5–3.5 mm.
glenoid at the desired angle and position, ensuring
the pin engages or perforates the medial cortical wall
(Figure 25). A completely secure Steinmann pin is
essential to ensure the subsequent reamer has a stable
cannula over which to ream. A 10 degree inferior tilt has
been built into the glenoid sizer, however any glenoid
defects or asymmetric wear needs to be accounted for
when the Steinmann pin is placed correctly within the
guide, it will lie flush with the inferior groove.
Figure 26
Figure 26a
Glenoid (cont.)
Note: Obtaining a pre-operative CT scan will help Remove the cannulated glenoid reamer, ensuring the
identify bone erosion which may affect glenoid tilt Steinmann pin remains securely positioned in the
and/ or version. It also helps locate quality bone in glenoid (Figure 26a). If the Steinmann pin comes out,
which to place the baseplate. the baseplate trial can be used to reposition and place
the Steinmann pin into the glenoid.
Position the cannulated baseplate reamer over the top
of the Steinmann pin (Figure 26). Ream the glenoid Note: There is not a stop on the glenoid reamer,
to the desired level, ensuring the medial geometry so continual attention to the reaming depth is
of the glenoid baseplate is completely reamed. Due important.
to the 10 degree inferior tilt of the Steinmann pin
sizer, an inferior ridge should be evident first. A slight
superior bone ridge should then follow, ensuring full
concentric reaming. It is common to see cancellous
bone inferiorly, while cortical bone remains superiorly.
It is critical that the glenoid is adequately reamed to
ensure complete seating of the glenoid baseplate
(Figure 26a). Depending on the condition of the
glenoid, the baseplate can be partially counter-sunk.
This is accomplished by sinking the glenoid reamer
until the desired inferior bone shelf is evident.
Gold
Figure 27 Figure 28
Glenoid (cont.)
It is critical to remove any excess bone and soft tissue Method 2: If the instrumentation that features the calcar
from the glenoid face (typically inferior) that may planer is available, select and attach the appropriate
prevent complete impaction of the glenosphere/taper planer blade based on the size of glenosphere desired
assembly into the baseplate. This can be done with to the planer. Position the cannulated glenoid planer
two different methods. over the top of the Steinmann pin. Concentrically
plane the glenoid face, ensuring any adhesions and
Method 1: Using the cannulated trial glenoid baseplate, soft tissues are removed from the face of the glenoid
position the glenoid baseplate provisional over the (Figure 28). Remove the cannulated glenoid planer,
Steinmann pin and into the prepared glenoid. If there ensuring that the Steinmann pin remains securely
appears to be any bone and/or soft tissue that extends positioned in the glenoid.
past the face of the trial glenoid baseplate, utilize a
ronguer to trim this unwanted bone down to ensure If additional bone or soft tissue are present on the
complete seating of the glenosphere (Figure 27). inferior shelf or the included planer is too large to
insert into the joint space, utilize a ronguer to trim
unwanted bone to ensure complete seating of the
glenosphere. If the glenoid baseplate provisional does
not fully seat in either of these methods, the baseplate
reamer should be used to completely prepare the
baseplate geometry.
Figure 29 Figure 30
Glenoid (cont.)
Baseplate Impaction
Application of saline or other appropriate lubrication The glenoid baseplate is now seated, and determination
to impactor tip o-ring should aid in distraction of of the appropriate length 6.5 mm central screw can be
impactor from baseplate after impaction. Place made (Figure 30).
the glenoid baseplate implant onto the end of the
cannulated baseplate impactor (Figure 29). Reference
the screw hole indicator hashmarks and grooves on the
impactor to align the peripheral hole screw position as
desired. All peripheral screw holes on the baseplate
are identical, which allows them to be placed in any
desired location. Once aligned, impact the baseplate
into the glenoid and remove the baseplate impactor.
The back of the baseplate should be fully seated on
the face of the glenoid surface. Visual confirmation can
be attained by checking for gaps between the reamed
glenoid surface and baseplate at the screw holes.
A small nerve hook may aid in confirming complete
seating of the baseplate. Due to the 10 degree inferior
to superior orientation for the baseplate preparation,
the baseplate may be partially or fully counter-sunk
inferiorly.
Standard Base Plate
Mini Base Plate
Figure 31 Figure 32
Glenoid (cont.)
Baseplate Central Screw Selection/Insertion
6.5 mm central screw length determination may be Note: 110025762 measures screw depth for the
made in one of the three following methods: mini baseplate central screw, standard baseplate
central screw and peripheral screws for both the
1. With Steinmann pin in place, position the central
mini and standard baseplates.
screw drill guide over the pin and read the
corresponding depth marking on the pin from the
back of the drill guide (Figure 31).
2. If Steinmann pin is removed or falls out, insert the

central screw drill guide into the glenoid baseplate
and drill a 3.2 mm diameter hole to the desired
depth. Read corresponding depth marking on the
3.2 mm diameter drill from the back of the drill
guide (Figure 31).
3. If Steinmann pin is removed or falls out, place the

depth gauge (110025762, 405829) into the reverse
Morse central taper of the glenoid baseplate and read
the corresponding depth marking from the gauge
(Figure 32).
Figure 34
Incorrect Correct
Figure 33 Figure 34b Figure 34a
Glenoid (cont.)
Insert the desired length 6.5 mm central screw If the guide does not sit flush, the central screw is
(Figure 33) and completely tighten with the 3.5 mm not completely tightened. Additional effort should
hex driver. To verify the 6.5 mm central screw is fully be made to inspect for unwanted soft tissue or debris
seated in the baseplate, a check with the central behind the screw head; then fully seat the central
screw drill guide should be performed. Simply attach screw. A fully seated central screw provides the best
the central screw drill guide/ template to the guide compression and fixation, as well as ensures the male
handle, and insert the guide into the reverse Morse taper of the glenosphere will fully engage.
taper of the baseplate (Figure 34). If the guide sits
Tip: The most common lengths of the central screw
flush on the baseplate without rocking or toggling,
are 25 – 35 mm.
the central screw is completely and correctly seated
(Figure 34a & 34b).
Figure 35 Figure 36
Glenoid (cont.)
Peripheral Screw Selection/Insertion
Method 1: Fixed Angle Only
Position the peripheral drill guide with bushing insert Select and tighten the appropriate length 4.75
on the baseplate and drill the superior hole using 2.7 mm screw through the channel in the drill guide
mm drill (Figure 35). using the 3.5 mm hex driver, and into the baseplate
without completely tightening (Figure 36). Rotate the
Ensure the drill bushing is flush with the guide when peripheral drill guide and bushing 180 degrees and
reading the depth markings off of the drill. Remove the repeat for opposing screw. Repeat these steps for the
drill bushing insert from the guide. remaining two peripheral screws.
Warning: It is important to ensure the screw driver and

screw are parallel with each other and fully engaged
as you insert the screws using the included ratchet
handle and driver. Do not insert screws under power.
Deviation from this technique may lead to stripping of
the driver and screw interface. Once the screws are
fully seated in the baseplate, do not over-tighten.
Note: It is advisable to inspect all screw drivers

after each surgery and replace as necessary.
Tighten all peripheral locking screws in an alternating

fashion until fully seated to complete baseplate screw
insertion (Figure 37).
Figure 37 Figure 38
Glenoid (cont.)
Tip: The most common lengths of superior and inferior Note: The text written on the Zimmer-Hudson
screws are 25 – 35 mm. The most common length connection (3.5 mm hex or 2.5 mm hex) of the
of anterior and posterior screws is 15 mm. Typically, peripheral drivers should be used to visually
locking screws are used for all peripheral holes. identify the type of driver.
However, the non-locking screws may be used to
obtain compression and variability in the screw angle. Peripheral Screw Selection/Insertion
Method 2: Fixed Angle and Variable Angle
Note: When used with locking screws, the As an alternative to using the peripheral drill guide
baseplates peripheral holes are fixed at a 5 degree with bushing insert, the peripheral drill guides (fixed
diverging angle. angle or variable angle) which thread into each
baseplate peripheral hole may be used. The threaded
Note: A yellow mark has been added to the 3.5
peripheral drill guide is threaded into the baseplate
mm hex driver to indicate when the screw is
(Figure 38). With the 2.7 mm peripheral drill bit, drill
approaching the baseplate threads (when used
the superior hole and read the desired depth marking
with the captured peripheral drill / screw guide).
at the end of the drill guide. Unscrew the threaded
As the yellow mark begins to disappear into the
peripheral drill guide from the baseplate, and insert
captured peripheral drill / screw guide, the screw
the appropriate peripheral screw. Repeat until all four
threads are approximately 2.5 mm from completely
peripheral screws are inserted, and fully tighten in an
seating. When the yellow mark can no longer be
alternating fashion.
seen, the threads on the head of the screw are
within approximately one complete turn of seating
in the baseplate.
Peripheral
Screw
Figure 39 Figure 40
Glenoid (cont.) Glenosphere Selection

Note: If using the variable-angle threaded Select the appropriately sized glenosphere trial and
peripheral drill guide, the non-locking 4.75 mm assemble to a trial taper adaptor. Determine the
peripheral screw must be used. Six degrees of amount and orientation of glenosphere offset, keeping
angulation in any direction is possible. in mind that a fully inferior offset glenosphere provides
the best opportunity to minimize or eliminate scapular
Note: If using the fixed-angle threaded peripheral notching (Figure 40). However, it is possible to orient
drill guide, either the locking or non-locking 4.75 the glenosphere offset in any direction including
mm peripheral screws may be used. anterior/ posterior, which may help with instability.
Glenosphere provisionals are marked with an arrow to
Note: 110025762 measures screw depth for the show offset direction.
mini baseplate central screw, standard baseplate
central screw and peripheral screws for both the In addition to the amount and direction of offset,
mini and standard baseplates. medialized or lateralized center of rotation glenospheres
(+3 mm, +6 mm) are available depending on preference.
Tip: The most common glenospheres used are 36 mm.
Glenospheres are offered in 40 mm and 41 mm sizes

as well.
Figure 41 Figure 42
Glenoid (cont.) Glenosphere Offset

After desired positioning of glenosphere trial is Remove the glenosphere trial assembly from the
achieved, tighten the taper adaptor trial in the head glenoid baseplate. Determine the amount of offset
trial with the appropriate hex driver (Figure 41). needed by referencing the A, B, C, D, and E *
indications on the underside of the trial glenosphere
Note: It may be helpful to use the trial glenosphere and trial adaptor (Figure 42). This offset indicator will
wrench for insertion and rotation of the trial be referenced when preparing the definitive implant.
glenosphere.
Note: The glenosphere removal fork may be
Note: An optional glenosphere trial inserter exists required to remove the trial glenosphere from the
to be used in conjunction with the slots located on glenoid baseplate.
the articulating surface of the glenosphere trial to
aid in the removal of the trial. Note: The glenosphere offset may be positioned
in any orientation relative to the glenoid baseplate,
keeping in mind that an inferior offset provides the
best opportunity to minimize scapular notching.
*The 36 mm standard glenosphere provisional is marked with B, C, D indications as the offset range is 1.5 mm to 3.5 mm for the definitive implant.
Figure 43a Figure 44a
Figure 43 Figure 44
Glenoid (cont.)
Glenosphere Assembly
Place the glenosphere implant into the impactor base Engage the Morse taper with two firm strikes, using
(110027886 or 407281). Ensuring the components the taper impactor tool (407280 or 110029132) and
are clean and dry, insert the taper adaptor into the mallet (Figure 43 and 44). The taper/ glenosphere
glenosphere (Figure 43a & 44a). Rotate the taper assembly is now secure.
adaptor until the trial offset is replicated. For example,
if trialing indicated a fully offset glenosphere (position Note: In the event the taper has been engaged in
E), the implant taper adaptor is aligned so that the an incorrect position, the Versa-Dial taper extractor
hashmark is positioned at position E on the definitive (407298), located in the humeral preparation tray,
glenosphere head (Inset). may be used to remove the taper adaptor from the
glenosphere. After removal of the taper adaptor, a
new taper adaptor should be used.
Offset Indicator Offset*
A 0.5 mm
B 1.5 mm
C 2.5 mm
D 3.5 mm
E 4.5 mm
*For 36 mm Standard Glenosphere, the offset range is 1.5– 3.5 mm (B–D).

Figure 45 Figure 46
Glenoid (cont.)
Glenosphere/Taper Adaptor
Offset Direction Determination
Place the glenosphere into the orientation block Slide the 2-prong glenosphere inserter/impactor
(110027886 or 407281) for determination of offset onto the glenosphere and tighten. Another option
direction. Rotate the glenosphere until the implant is to place the glenosphere forceps over the top
reaches the point that is furthest on the orientation of the glenosphere and tighten using a ratcheting
block scale. This orientation will represent the direction mechanism (Figure 46).
of maximum offset (Figure 45).
As an alternative to the glenosphere inserter, a surgical
marker can be used to note the direction of the offset
on the rim of the glenosphere. The glenosphere can
then be inserted into the baseplate by hand.
Figure 47 Figure 48
Glenoid (cont.) Humeral Tray and Bearing

Glenosphere Orientation/Impaction Humeral Tray and Bearing Preparation
Once the reverse Morse taper of the baseplate has Select the appropriately sized one-piece trial
been cleaned and dried, engage the glenosphere humeral tray/ bearing. Noting the “SUPERIOR” and
using the forceps, and implant the glenosphere in “INFERIOR” markings on the humeral tray, place the
the same orientation as the trial (Figure 47). If using trial humeral tray/bearing into the Comprehensive
the 2-prong glenosphere inserter, you may strike the broach/trial (Figure 48) and perform a trial reduction
end of the instrument to engage the glenosphere to assess range of motion and implant size selection.
and taper assembly into the baseplate. If using the The included shoe horn may be helpful in reducing
4-prong forceps inserter, it is recommended to the joint. The trial reduction should show very limited
hold the glenosphere while it is positioned within distraction (1 mm or less).
the baseplate. With two firm strikes, the concave
Note: The trial humeral tray/bearing will not engage
glenosphere impactor (407280 or 110029132) should
the broach/stem if the broach/stem is counter-sunk
be used to engage the glenosphere into the baseplate.
and/or does not match the version/inclination of
A screw is not needed to attach the glenosphere to
the humeral cut. If the broach/stem is counter-sunk
the baseplate. The design of the Morse tapers provide
and/or does not match the humeral cut version/
secure fixation.
inclination, re-position the broach/stem higher or
remove the appropriate amount of bone in order for
the trial humeral tray/bearing to seat.
Note: Mini Humeral Tray and Bearing Provisionals

can also be used with this system. Please refer to
Surgical Technique Addendum for Mini Humeral
Tray: 1998.1-GLBL
Laser etch
alignment marks
Figure 49
Humeral Tray and Bearing (cont.) Humeral Tray and Bearing Assembly
Note: In cases of extreme instability, +3 mm Utilize the bearing assembly tool to first spread the
retentive humeral bearings are available. Retentive RingLoc ® locking mechanism to the open position by
bearings capture more of the glenosphere and fully seating the bearing assembly tool on the humeral
have polyethylene walls which are 2– 3 mm higher tray. An audible “click” will be heard when the bearing
than standard +3 mm bearings, but do not add any assembly tool is properly engaged. Next, place the
additional joint space. Depending on variations in engaged bearing assembly tool and humeral tray on
instrument tray layouts, the retentive bearings may the glenosphere offset orientation block. Position the
be found in the revision instrument tray. definitive humeral bearing in the definitive humeral tray,
ensuring that the laser etching on the bearing aligns
Note: Additional humeral resection and subsequent with the laser etching on the humeral tray. Using the
re-reaming and re-broaching may be required if the humeral bearing/tray impactor tool, apply downward
joint is extremely difficult to reduce. pressure to the bearing and remove the bearing
assembly tool continuing to apply downward pressure
Note: Glenospheres and humeral bearings on the bearing. With two firm strikes of the humeral
have been color coded to ensure only matching tray/ bearing impactor (405825 or 110028055),
curvatures are used together. impact the humeral bearing into the humeral tray
(Figure 49). Following inspection, ensure the humeral
Tip: The most common thickness of the tray and
bearing is fully seated within the humeral tray.
bearing is standard for each (STD-STD).
Note: Mini Humeral Tray and Bearing Implants
can also be used with this system. Please refer to
Surgical Technique Addendum for Mini Humeral
Tray: 1998.1-GLBL
Figure 50
Humeral Tray and Bearing (cont.)

Humeral Tray/Bearing Impaction Subscapularis Repair
Clean and dry the reverse Morse taper of the stem. There is some evidence that the subscapularis
With two firm strikes of the humeral tray/ bearing improves the stability of the implant. Therefore, when
impactor, impact the assembled definitive humeral possible, the subscapularis should be repaired at the
tray/bearing into the Comprehensive stem. completion of the procedure, as long as it does not
The humeral tray is marked “SUPERIOR” to aid in significantly reduce external rotation. If the tissue at
positioning the tray/bearing with respect to the the lesser tuberosity is poor, place sutures through the
stem. When inserted correctly, the thicker portion bone prior to implantation of the stem.
of the polyethelyne bearing should be inferior.
Reduce the joint with the aid of the shoe horn and
assess the final range of motion. The final reduction
(Figure 50) should show very limited distraction
(1 mm or less). Impingement should not be present
in either adduction or abduction. If impingement
occurs in abduction, a greater tuberosity osteotomy
or tuberoplasty may be necessary.
Figure 51 Figure 52
Revision Options Polyethylene Preparation

Depending on variations in instrument tray layouts, After gaining access to the implanted glenoid, section
revision instruments may be found in the revision off the three peripheral pegs by making three cuts in
instrument tray. a triangular fashion around the central peg using an
oscillating saw (Figure 52).
Removal of Glenosphere/Baseplate
Remove the Versa-Dial glenosphere with the low- This will allow the removal of the outer portion of the
profile head removal fork. Once the glenosphere is polyethylene glenoid independently from the central
removed, the peripheral and central screws should be portion.
removed with the appropriate size hex driver.
Polyethylene Removal
The baseplate should be completely removed by first Using a thin osteotome or rongeur, remove the outer
positioning the two peripheral colletts of the baseplate portion of the polyethylene glenoid, including the
extractor into the opposing holes in the glenoid
cemented peripheral pegs (Figure 52)
baseplate and fully tightening (using the 2.5 mm hex
driver) and secondary, inserting the threaded shaft The central portion of the polyethylene can then
into the central portion of the baseplate extractor and be unthreaded from the well-fixed polyethylene or
turning clockwise with the included extraction bar. Regenerex central post.
This will expand the collet located at the end of the
baseplate extractor (Figure 52). Once secure, a slap-
hammer can be used to fully remove the baseplate. It
may be desirable to use autograft/allograft material
on the glenoid at this time, before proceeding to
complete the salvage hemi-arthroplasty.
Figure 53 Figure 54
Central Post Removal Salvage Hemi-arthroplasty

Thread the guide rod onto the central post. Using In the event a Comprehensive Reverse Shoulder fails,
the guide rod as a cannula, proceed to cut down over a salvage hemi-arthroplasty may be the only option
the central post using the trephine (Figure 53). Once for a patient. A salvage reverse to hemi-arthroplasty
the trephine has bottomed out on the central post, conversion may be accomplished without removing a
remove the trephine from the joint. The guide rod can Comprehensive stem.
now be used to remove the central post.
Removal of the Humeral Tray/Bearing
Note: This technique and instrumentation can be
The humeral tray/bearing assembly may be removed
used with either previously implanted Polyethylene
with the low-profile removal fork. As the humeral tray
or Regenerex central post.
sits very near the resected surface of the humerus and
Note: The outer diameter of the trephine is smaller the stem collar lies within the counter-bore geometry
than the outer diameter of the Reverse Standard of the humeral tray, it is preferable to place one of
Baseplate central boss and equal to the outside the removal fork arms between the humeral tray and
diameter of the Reverse Mini Baseplate. This will leave stem collar, which will act as a wedge and disengage
enough glenoid bone for the Comprehensive Reverse the taper from the stem. Once the humeral tray/
Baseplate Reamer to achieve cancellous reaming. bearing assembly is removed and the stem taper has
been cleaned and dried, a large Versa-Dial or EAS
Note: When considering which reverse baseplate humeral head may be inserted and engaged into the
to use on a revision, consider that there will be more Comprehensive stem (Figure 54).
interference fit on the standard baseplate as compared
to the mini baseplate. This is due to the dimension of
the boss being larger on the standard baseplate.
Figure 55a
Fracture Stem Revision Stem
Figure 55 Figure 56
Central Post Removal (cont.)

Note: Utilize part #407389 to remove the titanium When a bearing is removed, a new locking ring (size
humeral tray/bearing assembly. Utilize part 21, #106021) should be placed into the humeral tray
#406920 to remove the cobalt chrome humeral before the new bearing is locked in place. A correctly
tray/bearing assembly. The cobalt chrome tray has positioned locking ring should open towards the
removal slots that fit the low-profile removal fork for superior portion of the humeral tray as shown in
easier removal in an anterior/posterior direction. (Figure 55a).
Polyethylene Humeral Bearing Other Stem Options

Removal/Exchange
The Comprehensive Fracture and Revision stems
If a humeral bearing needs to be replaced, the RingLoc (Figure 56) are compatible with the Comprehensive
locking mechanism of the humeral tray will allow for Reverse Shoulder. For the complete Comprehensive
exchange/revision of bearings without tray removal Fracture Stem Technique, please see BOI0274.0.
(Figure 55). To remove a humeral bearing, simply
expand the locking ring using the Ringloc liner removal Note: Revision broaches are available for order.
tool. Position the curved portion of the tip towards the Flexible hip reamers can be used in conjunction with
bearing and insert between the open portion of the the revision length broaches in order to prepare the
locking ring. This will expand the ring. Once the ring distal humeral canal. Standard humeral reamers
has been expanded, slide the removal tool down and should be used to prepare for the proximal stem
then underneath the bearing. The humeral bearing is geometry. Similar to the standard length stem,
now released. ream so that the etched line is even with the greater
tuberosity.
Figure 57 Figure 58
Fracture: Tuberosity Reconstruction

Tuberosity reconstruction is just as important in Next, place the superior and inferior greater tuberosity
Reverse Total Shoulder Arthroplasty for fracture as sutures through the superior and inferior holes in the
it is Hemi Arthroplasty for fracture of the proximal prosthesis fin. Continue with these sutures through
humerus. The procedure is similar in both procedures the bone tendon interface of the lesser tuberosity at
and involves longitudinal and transverse fixation of corresponding levels (Figure 58).
the tuberosities to the humeral shaft and themselves
around and/or through the implant.
Proximal Humerus Fractures

There are many acceptable variations, including using
the humeral tray suture slots for reconstruction of
the tuberosities. However, the goal is to securely fix
the greater and lesser tuberosities to the shaft and to
each other. Tuberosity clamps can be used to secure
tuberosities during reconstruction.
Place three #5 nonabsorbable sutures through the

bone tendon interface of the greater tuberosity. Place
the middle greater tuberosity suture through the
suture hole on the medial neck of the prosthesis
(Figure 57).

(cont.)
Pass the longitudinal suture, previously placed through Tie these sutures in the appropriate order to first
the lateral hole in the humeral shaft, above the greater secure the greater tuberosity to the humeral shaft
tuberosity. Continue with this suture underneath the and to the prosthesis (Figure 60) and then to secure
greater tuberosity sutures (Figure 59). the lesser tuberosity to the humeral shaft and to the
greater tuberosity (Figure 61).
Figure 62

(cont.)
Place the figure-of-eight suture that was placed
prior to stem insertion from back to front through
the rotator cuff and close above the tuberosities,
fixing the tuberosities to the humeral shaft (Figure
62). If a primary reverse arthroplasty for proximal
humeral fracture is being performed, insert bone
graft from the humeral head below the tuberosities.
Improper positioning of the tuberosity may cause
abnormal tensioning on any remaining rotator cuff
tendons and could lead to impingement. Place the
shoulder through a range of motion, noting stability
of the tuberosities. This will allow guidance for the
postoperative rehabilitation program.
Humeral Stem Sizing

Standard Stem Mini Stem
Last Reamer Used Broach to Size Implant Size Last Reamer Used Broach to Size Implant Size
20 STD / 19 MI 20 mm 20 mm 20 STD / 19 MI* 20 mm 20 mm

19 STD / 18 MI 19 mm 19 mm 20 STD / 19 MI 19 mm 19 mm
16 STD / 15 MI 16 mm 16 mm
17 STD / 16 MI 16 mm 16 mm
15 STD / 14 MI 15 mm 15 mm
16 STD / 15 MI 15 mm 15 mm
14 STD / 13 MI 14 mm 14 mm
15 STD / 14 MI 14 mm 14 mm
13 STD / 12 MI 13 mm 13 mm
14 STD / 13 MI 13 mm 13 mm
12 STD / 11 MI 12 mm 12 mm
13 STD / 12 MI 12 mm 12 mm
11 STD / 10 MI 11 mm 11 mm
5 STD / 4 MI** 5 mm 5 mm 7 STD / 6 MI 6 mm 6 mm
4 STD** 4 mm 4 mm 6 STD / 5 MI 5 mm 5 mm
4 STD** 4 mm 4 mm
5 STD / 4 MI** 5 mm 5 mm
**Since there are no numeric hashmarks on the teeth of these reamers, ream to
the horizontal hashmark. 4 STD** 4 mm 4 mm
*Ream to horizontal hashmark in order to implant the 20 mm mini stem, as there is
not a larger reamer to facilitate reaming to a point between the 3 and 4 hashmark.
**Since there are no numeric hashmarks on the teeth of these reamers, ream to
the horizontal hashmark.
Humeral Stem Sizing (cont.)

Micro Stem
Last Reamer Used Broach to Size Implant Size
20 Micro 20 mm 20 mm
9 Micro 9 mm 9 mm
8 Micro 8 mm 8 mm
7 Micro 7 mm 7 mm
6 Micro 6 mm 6 mm
5 Micro 5 mm 5 mm
4 Micro 4 mm 4 mm
Comprehensive Fracture System Sizing Chart

Reamer Bone Tap Positioning Sleeve Sleeve Inserter Fracture Stem
6 mm 6 mm 6 mm 6 mm or 7 mm 4 mm
7 mm 7 mm 7 mm
8 mm 8 mm 8 mm 8 mm or 9 mm 6 mm
9 mm 9 mm 9 mm
10 mm 10 mm 10 mm 10 mm or 11 mm 8 mm
11 mm 11 mm 11 mm
12 mm 12 mm 12 mm 12 mm or 13 mm 10 mm
13 mm 13 mm 13 mm
14 mm 14 mm 14 mm 14 mm or 15 mm 12 mm
15 mm 15 mm 15 mm
16 mm 16 mm 16 mm 16 mm or 17 mm 14 mm
17 mm 17 mm 17 mm
Implants
Product Description Size Part Number
Versa-Dial Glenosphere Standard 36 mm 115310

Versa-Dial Glenosphere +3 mm 36 mm 115313
Versa-Dial Glenosphere Standard 41 mm 115320
Versa-Dial Glenosphere Standard Titanium 36 mm TI-115310

Versa-Dial Glenosphere +3 mm Titanium 36 mm TI-115313
Versa-Dial Glenosphere Standard Titanium 41 mm TI-115320
Versa-Dial Taper Adaptor — 118001
Glenoid Baseplate 28 mm 115330
Comprehensive Mini Baseplate 25 mm 010000589

and Taper Adaptor
Humeral Tray Standard - Titanium 44 mm 115360*

Humeral Tray +5 mm - Titanium 115365*
Humeral Tray +10 mm - Titanium 115368*
Cobalt Chrome Standard Humeral Tray 44 mm 115370

Cobalt Chrome +5 Humeral Tray 115375
Cobalt Chrome +10 Humeral Tray 115378
— RingLoc Replacement Humeral Tray Ring 21 106021
ArComXL® Standard Humeral Bearing 44–36 mm XL-115363

ArComXL +3 mm Humeral Bearing 44–36 mm XL-115364
ArComXL Retentive +3 mm Humeral Bearing 44–36 mm XL-115365
ArComXL Standard Humeral Bearing 44–41 mm XL-115366
ArComXL +3 mm Humeral Bearing 44–41 mm XL-115367
ArComXL Retentive +3 mm Humeral Bearing 44–41 mm XL-115368
E1® Standard Humeral Bearing 44–36 mm EP-115393

E1 Standard +3 mm Humeral Bearing 44–36 mm EP-115394
E1 Retentive +3 mm Humeral Bearing 44–36 mm EP-115395
E1 Standard Humeral Bearing 44–41 mm EP-115396
E1 Standard +3 mm Humeral Bearing 44–41 mm EP-115397
E1 Retentive +3 mm Humeral Bearing 44–41 mm EP-115398
* Alternate part numbers for Ti trays (115340, 115345 & 115348) are not CE marked.
Implants (cont.)
Product Description Size Implant Part No. Broach/Trial Part No.
Comprehensive Humeral Stem—Micro 4 mm 113604 405304

Comprehensive Humeral Stem—Mini 4 mm 113624 407304

Comprehensive Humeral Stem—Mini 18 mm* 113638 407318
*Available by special order
Implants (cont.)
Comprehensive Humeral Stem—Standard 4 mm 113644 407304

Comprehensive Humeral Stem—Standard 18 mm* 113658 407318
As an alternative standard (122 mm) length broaches are available by special order.
Comprehensive Humeral Stem—Fracture 4 mm 11-113554 31-406904

Comprehensive Humeral Stem—Revision 4 mm 113664 407344** 407346**

Comprehensive Humeral Stem—Revision 10 mm 113670
*Available by special order

**Available through loaner department
Implants (cont.)
6.5 mm Central Screw 3.5 Hex 20 mm length 115394

4.75 mm Fixed Locking Screw 3.5 Hex 15 mm length 180550

4.75 Variable Non-Locking Screw 3.5 Hex 15 mm length 180557

F J
A H
E
G
B
D I
110028913 Comprehensive Reverse Glenoid Preparation Tray (Generation 2)
Product Description Label Size Part Number
Steinmann Pin A 9 in. 405800
Glenoid Guide Handle B, I — 406849
Mini Baseplate Sizer w/ C — 110027742

10 degree Tilt
Mini Baseplate Reamer D — 110029136
— Future Expansion E — —
Mini Baseplate Trial F — 406205
Mini Baseplate Impactor G — 405809
Central Screw Drill H 3.2 mm Ø 405883
Mini Baseplate Central J 3.2 mm Ø 406206

Screw Drill Guide
K N
L M P
110028913 Comprehensive Reverse Glenoid Preparation Tray (Generation 2) (cont.)
Depth Gauge (Mini, Std, K — 110025762

Peripheral)
Hex Driver L 3.5 mm Ø 110010424
Ratchet Handle M — 405908
Peripheral Screw Drill N 2.7 mm Ø 405889
Mini Baseplate Inferior/Superior O — 406207

Drill Guide
Inferior/Superior Drill Guide P — 405833

Bushing
Variable Angle Drill Guide Q — 405881
Fixed Angle Drill Guide R — 405880

H K
A
C
G J
D
B
E
F I
110028913 Comprehensive Reverse Glenoid Preparation Tray
36 mm Glenosphere Provisionals A Standard 110029302

+3 mm 110029303
+6 mm 110029304
41 mm Glenosphere Provisionals B Standard 110029305

+3 mm 110029306
+6 mm 110029307
Mini Baseplate Taper Adapter Trial C — 110028878

(use with driver #110010424)
Hex Driver D 3.5 mm 110010424
Glenosphere Provisional Rotation Tool E — 110028438
36 mm Standard Humeral Tray/ F Standard 405940

Bearing Provisionals +3 mm 405950
36 mm +5 mm Humeral Tray/ G Standard 405945

36 mm +10 mm Humeral Tray/ H Standard 405948

41 mm Standard Humeral Tray/ I Standard 405970

41 mm +5 Humeral Tray/ J Standard 405975

41 mm +10 Humeral Tray/ K Standard 405978

R
N
L
Q
O
M
110028913 Comprehensive Reverse Glenoid Preparation Tray
Product Description Label Part Number
Shoehorn L 405901
Glenosphere Removal Fork M 405832
Metal Impactor N 110029132
Humeral Bearing O 110017268

Assembly Tool
Offset Orientation Block / P 110027886

Taper Impaction Base
Polyethylene Impactor Q 110028055
2-Prong Glenosphere Inserter/ R 110028879

Impactor
— Replacement Glenosphere — 110028920

Trial Bin
— Replacement Humeral Bearing — 110028921

Trial Bin
A
B
C D
G
E F
H
I
110028915 Comprehensive Reverse Revision Tray
Ringloc+ Liner Release Tool A — 31-424206
Humeral Tray Removal Fork B — 406920
36 mm +3 mm Retentive C Standard 405960

Humeral Tray/Bearing +5 mm 405965
Provisionals +10 mm 405968
41 mm +3 mm Retentive D Standard 405990

Humeral Tray/Bearing +5 mm 405995
Provisionals +10 mm 405998
Standard Baseplate Taper E — 110028880

Adapter Trial (use with driver
#110010424)
Glenoid Removal Rod F 2.5 mm 110003486
Hybrid ® Glenoid Removal G — 110003486

Trephine
— Future Expansion H — —
Baseplate Extractor Bar I — 406668

J
K L
110028915 Comprehensive Reverse Revision Tray (cont.)
Hex Driver J 405885
Standard Baseplate Extractor K 405904
Mini Baseplate Extractor L 406209
— Replacement Retentive — 110028923

Humeral Bearing Trial Bin
C F G
110028914 Comprehensive Reverse Retractor Tray
Thin Glenoid Retractor A 405892
Wide Glenoid Retractor B 405893
2-Prong Forked Retractor C 110028403
Darrach Retractor D 405895
Golf Club Retractor E 405891
Bent Ring Fukuda Retractor F 994500850
Large Ring Fukuda Retractor G 406699

B
C
M N
A
D
O
E
F P
G S
R
I
H Q
J T
K L
595501 Comprehensive Reverse Glenoid Preparation Tray (Generation 1)
Sizer with 10 Degree A 28 mm 405802

Inferior Tilt
Guide Handle B — 406849
9 inch Steinmann Pin C 3.2 mm Ø 405800
Glenoid Baseplate Reamer D 28 mm 405806
Glenoid Planer with Blades E — 405890
Baseplate Provisional F 28 mm 405902
Glenoid Baseplate Impactor G 28 mm 405808
Steinmann Pin Puller H — 32-420160

595501 Comprehensive Reverse Glenoid Preparation Tray (cont.)

Ratcheting Handle I — 405908
Central Screw Depth Gauge J — 405831

Assembly
Central Screw Drill K 3.2 mm Ø 405883
3.5 Hex Central/Peripheral Screw L,S 3.5 mm 110010424

Driver
Peripheral Drill and Screw Guide M 28 mm 405882
Peripheral Drill Guide Insert N 2.7 mm 405833
Peripheral Screw Drill O 2.7 mm Ø 405889
Peripheral Screw Depth Gauge P — 405830

Assembly
Fixed Angle Drill Guide Q — 405880
Variable Angle Drill Guide R — 405881
Peripheral Screw Hex Driver S 2.5 mm 405885
Drill Guide/Template T 3.2 mm Ø 405884

(28 mm Baseplate)
E L
A
F K
B G H
C I
D J
595502 Comprehensive Reverse Glenoid Trial Tray
Taper Adaptor Provisional A — 405906
Versa-Dial Impactor Base B — 407281
Versa-Dial Trial Screwdriver C — 407296
Trial Glenosphere Wrench D — 405886
Glenosphere Provisional Standard E 36 mm 405810

Glenosphere Provisional +3 mm 36 mm 405813
Glenosphere Provisional Standard 41 mm 405820
Glenosphere Impactor F — 407297

595502 Comprehensive Reverse Glenoid Trial Tray (cont.)

Offset Orientation Block G — 405887
Baseplate Extractor H 28 mm 405904
Baseplate Extraction Bar I — 406668
RingLoc Liner Release Tool J — 31-424206
Glenosphere Removal Fork K — 405832
Versa-Dial Taper Impactor L — 407280

A
B
595503 Comprehensive Reverse Humeral Trial Tray
Shoehorn A — 405901
Humeral Bearing/Tray Impactor B — 405835
Humeral Bearing/Tray Trial, 44STD–36STD C 36 mm 405940

Humeral Bearing/Tray Trial, 44+5–36STD 405945
Humeral Bearing/Tray Trial, 44STD–36+3 405950
Humeral Bearing/Tray Trial, 44+5–36+3 405955
Humeral Bearing/Tray Trial, 44STD–36RET+3 405960
Humeral Bearing/Tray Trial, 44+5–36RET+3 405965
Humeral Bearing/Tray Trial, 44STD–41STD D 41 mm 405970

Humeral Bearing/Tray Trial, 44STD–41+3 405980
Humeral Bearing/Tray Trial, 44STD–41RET+3 405990
C
D
E G
595505 Comprehensive Retractor Set Total Instrument Case
Thin Glenoid Retractor A 405892
Wide Glenoid Retractor B 405893
2-Prong Capsular Retractor C 110028403
Modified Darrach Retractor D 405895
Golf Club Retractor E 405891
Bent Ring Fukuda F 994500850
Large Ring Fukuda G 406699

B
A
G F C
H I D
E J
E J
593690 Comprehensive Reverse Mini Baseplate Tray
Comprehensive Mini Baseplate Sizer A 25 mm 405803

with 10 Degree Inferior Tilt
Comprehensive Mini Glenoid B 25 mm 405807

Baseplate Reamer
Comprehensive Mini Glenoid Baseplate C 25 mm 405809

Glenoid Baseplate Impactor
Comprehensive Mini Baseplate Central D — 405829

Screw Depth Gauge Assembly
Comprehensive Mini Baseplate Taper Adaptor E 25 mm 405907

Provisional (use with driver #407296)
Comprehensive Mini Baseplate F — 405909

Calcar Planar Slide Shaft
Comprehensive Mini Baseplate Provisional G 25 mm 406205
Comprehensive Mini Baseplate H 3.2 mm Ø 406206

Drill Guide Template
Comprehensive Mini Baseplate I 25 mm 406207

Peripheral Drill and Screw Guide
Comprehensive Mini Baseplate Extractor J 25 mm 406209

Optional Instruments May Not Be Included In All Sets

Captured Sizer with 10 degree Inferior Tilt 28 mm 406202
2-Prong Glenosphere Inserter/Impactor* — 405900
Glenosphere Forcep* — 406236
Glenosphere Trial Inserter — 402640
Humeral Tray (with slots) Removal Fork — 406920
Humeral Head Removal Fork — 407389
Humeral Bearing Assembly Tool — 110017268
Screw Caddy — 180578
Comprehensive Reverse Templates — TMP-405801

*Not compatible with TM Reverse Glenospheres
This material is intended for healthcare professionals and the Zimmer Biomet
sales force. Distribution to any other recipient is prohibited. For indications,
contraindications, warnings, precautions, potential adverse effects and
patient counseling information, see the package insert or contact your
local representative; visit www.zimmerbiomet.com for additional product
information. All content herein is protected by copyright, trademarks and
other intellectual property rights, as applicable, owned by or licensed to
Zimmer Biomet or its affiliates unless otherwise indicated, and must not
be redistributed, duplicated or disclosed, in whole or in part, without the
express written consent of Zimmer Biomet.
For indications, contraindications, warnings, precautions, potential adverse
effects and patient counseling information, see the package insert or contact
your local representative; visit www.zimmerbiomet.com for additional
product information. Check for country product clearances and reference
product specific instructions for use. Zimmer Biomet does not practice
medicine. This technique was developed in conjunction with health care
professional. This document is intended for surgeons and is not intended
for laypersons. Each surgeon should exercise his or her own independent
judgment in the diagnosis and treatment of an individual patient, and
this information does not purport to replace the comprehensive training
surgeons have received. As with all surgical procedures, the technique
used in each case will depend on the surgeon’s medical judgment as the
best treatment for each patient. Results will vary based on health, weight,
activity and other variables. Not all patients are candidates for this product
and/or procedure. Caution: Federal (USA) law restricts this device to sale by
or on the order of a surgeon. Rx only.
©2019, 2021 Zimmer Biomet
Legal Manufacturer
Biomet Orthopedics
P.O. Box 587
56 E. Bell Drive 2797
Warsaw, Indiana 46581-0587 CE mark on a surgical technique
USA is not valid unless there is a CE
0173.4-GLBL-en-IssueDate 2021-12-21 www.zimmerbiomet.com mark on the product label.

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Comprehensive®

Patient Positioning, Surgical Incision/Exposure...................................................... 2

Glenoid components with Hydroxyapatite (HA)

Interlok ® finish humeral stems are intended for

Patient Positioning and Incision

Patient Positioning and Incision

Standard, Mini, and Micro Stem Technique

Standard Mini Micro

Figure 4 Figure 5 Figure 6

Micro Stem – Using the Micro length reamers, insert

Intramedullary Resection Guide

Note: The resection guide boom is NOT engraved

Intramedullary Resection Guide

Note: In chronic or fixed shoulders, a more

Intramedullary Resection Guide

Intramedullary Resection Guide

Intramedullary Resection Guide

Figure 16 Figure 17 Figure 18

Intramedullary Resection Guide

Humeral Broaching (cont.)

Note: An optional broach cover can be used to

Humeral Stem Insertion –

Humeral Stem Insertion –

Standard Base Plate

Mini Base Plate

2. If Steinmann pin is removed or falls out, insert the

3. If Steinmann pin is removed or falls out, place the

Figure 33 Figure 34b Figure 34a

Warning: It is important to ensure the screw driver and

Note: It is advisable to inspect all screw drivers

Tighten all peripheral locking screws in an alternating

Glenoid (cont.) Glenosphere Selection

Tip: The most common glenospheres used are 36 mm.

Glenospheres are offered in 40 mm and 41 mm sizes

Glenoid (cont.) Glenosphere Offset

Figure 43a Figure 44a

*For 36 mm Standard Glenosphere, the offset range is 1.5– 3.5 mm (B–D).

Glenoid (cont.) Humeral Tray and Bearing

Note: Mini Humeral Tray and Bearing Provisionals

Humeral Tray and Bearing (cont.)

Revision Options Polyethylene Preparation

Central Post Removal Salvage Hemi-arthroplasty

Fracture Stem Revision Stem

Central Post Removal (cont.)

Polyethylene Humeral Bearing Other Stem Options

Fracture: Tuberosity Reconstruction

Proximal Humerus Fractures

Place three #5 nonabsorbable sutures through the

Figure 59 Figure 60 Figure 61

Fracture: Tuberosity Reconstruction

Fracture: Tuberosity Reconstruction

Humeral Stem Sizing

20 STD / 19 MI 20 mm 20 mm 20 STD / 19 MI* 20 mm 20 mm

Humeral Stem Sizing (cont.)

Comprehensive Fracture System Sizing Chart

Product Description Size Part Number

Versa-Dial Glenosphere Standard 36 mm 115310

Versa-Dial Glenosphere Standard Titanium 36 mm TI-115310

Versa-Dial Taper Adaptor — 118001

Glenoid Baseplate 28 mm 115330

Comprehensive Humeral Stem—Revision 4 mm 113664 407344 407346