Thank you for the kind invitation. I have to tell you that one of the senior authors of this paper is also the designer of the implant I'm talking about, so be aware of that. I'm going to show you a quick video, although we're short on time, as some of you probably might not be familiar with the technique. So for partial humeral head resurfacing, you do a standard arthroscopy, you visualize the defect, you center a drill guide in the center of the defect, and you use a guide pin, and then you over-drill that guide pin, and you use a sleeve as a tissue protector to create a transhumeral portal for further instrumentation. That's shown here, coming through. And then you bring in a retrograde reamer through the rotator interval, and you catch that with a screwdriver, and then you ream in a retrograde fashion, you control the reaming, and then you take out the reamer, and you bring in the actual implant, you can shuttle this with sutures for example, then you connect that again with a retrograde screwdriver, you drive it in, and make it sit in the bone bed, and that's the final picture then. For a longer version of this video, just check out the room edit on there, and let's move on to our results. I'm very happy to show you, or present you now, our five-year data with this implant. I can show you 30 patients with a follow-up of five years, the indication for surgery always was a focal chondral defect, or beginning osteoarthritis with a central cartilage lesions in younger and or very active patients. So the clinical scores, they improved significantly from pre to post-operatively, and the scores stayed pretty, remained pretty stable up to a five-year outcome, follow-up, sorry. So then we took a look at the different implant sizes we used, as we thought they might have been used for slightly different pathologies. So we grouped them into the smaller ones, 20 and 25 millimeter diameter, and the bigger ones, larger ones, 30 and 35 millimeter diameter. The scores and outcome improved to baseline in both series, and there was actually no difference between the groups. The range of motion in those patients wasn't bad to begin with, and that didn't change actually until the five-year outcome. The pain significantly decreased from baseline. As you can see, it's not 100% perfect, they feel, they have some pain, but it remained low up to the five-year follow-up, and the patients seem overall to be happy with the function of their shoulders. So the overall revision rate in this five-year time period was 13.3%, and all due to progression of osteoarthritis. So we looked then in more detail at the causes of this failure, and we realized that it was among our first couple cases, and it was all those, the patients that failed, they also had higher grade glenoid defects, and when they failed, they failed more or less within a half a year, so the combination of a glenoid defect and the partial resurfacing turned out not to be a perfect combination. We changed our indications and avoided just doing the humeral side in patients with a glenoid defect. So another question that comes to mind is the safety of the transhumeral portal, and actually a study out of Chicago showed that you're away from the nerves, and in our own series, thankfully, we didn't have any neurological complications so far, probably due to using the sleeves and tissue protectors. In the beginning, we also were a bit worried if the implant would grow in, if it would have a secure fixation due to the retrograde drilling and so on, so we took histological samples of the revisions, and it turns out they are actually, they are fixated well, as you can see here, and actually we progressed a little to try them even in bad bone with avascular necrosis, where it's actually a very nice option, but it's not part of the talk, but it also seems to work. So in conclusion, arthroscopic partial humeral head resurfacing significantly improves, improved the outcome of the patients up to the five-year mark. We had a pretty low revision rate during that time period. There were no failures due to loosening or implant-related complication. Glenoid cartilage lesions turned out to be a contraindication for this technique, and so we think it's a viable option in those young and active patients with such contraindications. Thank you very much for your attention.

partial humeral head resurfacing

drill guide

retrograde reamer

implant

clinical scores