Comprehensive® Reverse Shoulder System

Restoring Function One Patient at a Time

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The Comprehensive® Reverse Shoulder System minimises the potential challenges of removing a well-fixed humeral stem by allowing conversion to a reverse shoulder using any of the existing Comprehensive Shoulder Stems.

Comprehensive Shoulder Stems:

  • Use the same Comprehensive platform stems (micro, mini, standard, fracture, and revision)
  • Can be used as primary reverse or conversion
  • Can be used in cemented or uncemented applications
  • Incorporate RingLoc® ArComXL® and E1® technologies into the design of the humeral tray and bearing
  • Come with PPS® Porous Plasma Spray Coating proximally to enhance biologic fixation (MacroBond® coating on fracture stem)
  • 45°/135° neck-shaft angle
  • Available in 69 stem sizes

Offering intra-operative flexibility, the Comprehensive Reverse Shoulder System provides a complete, seamless system based on the Comprehensive Shoulder platform.

PROVEN

Recognising the limitations of some reverse shoulders, innovation was engineered into each component of the Comprehensive® Reverse Shoulder System. Zimmer Biomet’s exclusive RingLoc® ArComXL® and E1® technologies have been incorporated into the design of the humeral tray and bearing. This provides a true locking mechanism and also minimises the potential for wear and oxidative degradation.1–8

 

Humeral Trays

  • Exclusive RingLoc® technology offers a true locking mechanism between the humeral tray and bearing
  • RingLoc technology allows for removal and exchange of the bearing without disruption of the humeral tray or stem
  • Available in standard, +5mm and +10mm
  • 6 suture slots provide for additional attachment points in complex fractures or revisions
  • Compatible with all humeral bearings and glenospheres

Humeral Bearings

  • ArComXL® Polyethylene bearing
  • Available in standard, +3mm and +3mm retentive
  • Includes 12° angle, making the neck-shaft angle 33°/147°
  • Anti-rotation tabs

Glenospheres

  • Versa-Dial® Glenosphere
    • Infinite offset options between 0.5mm and 4.5mm and can be positioned in any direction*
    • Medialised or lateralised centre of rotation (Standard, +3mm, +6mm)
    • Available in 36mm and 41mm
  • Fixed offset
    • Can be positioned in any direction
    • Medialised or lateralised centre of rotation (Standard and +6mm)

Glenoid Baseplate

  • Modular design allows for proper orientation of peripheral screw holes prior to impaction
  • Low-profile 28mm diameter
  • 4 identical peripheral locking screw holes
  • Central boss provides for potential of increased fixation and resistance to shear forces

Screw Options

  • Modular 6.5mm central screw allows for compression and increased fixation within the glenoid vault
  • Central screws are available in lengths of 20mm–50mm, in 5mm increments
  • 4.75mm fixed angle locking and non-locking screws are available
  • Non-locking peripheral screws provide for 12ºof flexibility

All peripheral screws are available in lengths of 15mm–45mm, in 5mm increments

VERSATILE

Full Suite of Glenoid Solutions

The glenoid is traditionally the most difficult part of a reverse shoulder procedure due to poor visibility of the scapula for assessment of the glenoid vault and glenoid version, minimal bone for fixation of the implants and determination of deltoid tensioning.  The surgery can become even more difficult with moderately to severely eroded glenoids. In order to address a wide range of possible patient anatomies, the Comprehensive Reverse System provides one of the most complete glenoid portfolios on the market and includes Mini and Standard Baseplates, Augmented Baseplates, Vault Reconstruction System and compatibility with Trabecular Metal™ Reverse System to solve any glenoid deficiency that comes your way.

SIMPLE

Instrumentation

Instrumentation can make big difference in a surgery. Good instrumentation should allow the patient and implant to come into focus. Comprehensive Reverse instrumentation was designed to be intuitive and complement the surgical work flow.

Humeral Stems

  • Titanium with proximal PPS® porous plasma spray
  • Convertible from anatomic (total) shoulder to reverse
  • 45°/135° anatomic neck-shaft angle
  • Four lengths: Micro, Mini, Standard and Revision
  • 4 – 20 mm diameters, in 1 mm increments
  • Fracture stem and SRS
  • 69 stem sizes
  • For use with or without bone cement

Mini Humeral Trays

  • Cobalt Chrome or Titanium
  • 40 mm diameter
  • Three height options (+0, +5, +10 mm)
  • Three offset posts options (+0, +3, +6 mm)

Mini Humeral Bearings

  • Vivacit-E® or Prolong® Highly Cross-Linked Polyethylene
  • Three height options (+0, +3 mm or +3 Retentive)
  • SIM-Loc™ Technology
  • Final Humeral Tray/Bearing inclination angle at 57°/147°

Baseplates

  • Modular design of baseplate and central screw allows for proper orientation of peripheral screw holes prior to impaction and the Central Boss provides for enhanced fixation and resistance to shear forces
  • Hydroxyapatite (HA) over PPS® porous plasma spray, over Titanium substrate
  • Mini Baseplate: Low-profile 25 mm diameter
  • Standard Baseplate:  28 mm diameter
  • Four identical peripheral locking screw holes

Augmented Baseplates

  • Designed with posterior half-wedge to maximize bone preservation.  
  • Superiorly directed Augment Baseplate may preserve subchondral bone and restore a natural, lateralized center of rotation benefitting soft tissue tensioning and stability
  • Available in small, medium and large.

Glenospheres

  • Constructed from Cobalt-Chrome or Titanium. Available in 36 mm or 40 mm diameter of curvature medialized or lateralized center of rotation (Standard, +3 mm, +6 mm)
  • Versa-Dial® technology to provide infinite offset options between 0.5 and 4.5 mm and can be positioned in any direction*

* 36 Glenosphere offset is between 0.5 and 3.5 mm

Screws

  • Modular 6.5 mm Central “compression” Screw, in lengths of 20–50 mm, in 5 mm increments, made from Titanium
  • 4.75 mm Fixed-Angle Locking and Variable-Angle Non-Locking Screws, in lengths of 15–45 mm, in 5 mm increments, made from Titanium
  • Ability to target good bone with 12° of screw angulation with non-locking screws
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Additional Information

Surgical Techniques

References

  1. Vivacit-E Vitamin E Highly Crosslinked Polyethylene Long-Term Performance for High Demand Patients.  Zimmer Technical Memo, 2014.  Literature # 97-7255-181-00 Rev 1. (Laboratory studies are not necessarily indicative of clinical performance.)
  2. Peiserich M, et al. Retention of Mechanical Properties in a Blended Vitamin E Polyethylene After Extreme Oxidative Challenge. Poster 1060, ORS 2013 Meeting. 2013. (Laboratory studies are not necessarily indicative of clinical performance.)
  3. Mimnaugh,K. et al. 100 Million-Cycle Wear Evaluation of Crosslinked Vitamin E Grafted Polyethylene (VE-HXPE) Acetabular Liners. Paper No. 0403. ORS 2016 Annual Meeting (Laboratory studies are not necessarily indicative of clinical performance.)
  4. Zimmer Prolong Highly Crosslinked Polyethylene Brochure.  Literature #: 97-5952-101-00 Rev 2. (Laboratory studies are not necessarily indicative of clinical performance.)
  5. Xinning L, Dines J, Warren R, Craig E, Dines D.  Inferior Glenosphere Placement Reduces Scapular Notching in Reverse Total Shoulder Arthroplasty. Orthopedics. 2015; 38(2):e88-e93.
  6. Jost, Patrick W, Dines, Joshua S, Griffith, Matthew H, Angel, Michael, Altcheck, David W, Dines, David M.  Total Shoulder Arthroplasty Utilizing Mini-Stem Humeral Components: Technique and Short-Term Results.  HSSJ (2011) 7:213-217.
  7. Wagner, Eric R, Statz, Joseph M, Houdek, Mathew T, Cofield, Robert H, Sanchez-Sotelo, Joaquin, Sperling, John W.  Use of a shorter humeral stem in revision reverse shoulder arthroplasty.  J Shoulder and Elbow Surg. 2017.
  8. S.A. Guiseffi, P Streubel, J. Sperling, J. Sanchez-Sotelo. Short-stem uncemented primary reverse shoulder arthroplasty.  The Bone & Joint Journal.  2014; 96-B: 526-9.
  9. Comprehensive Reverse Shoulder Post-Market Clinical Study (Protocol EX007).  September 2018 Annual Report.
  10. Werner B, Dines J, Dines D. Platform systems in shoulder arthroplasty. Curr Rev Musculoskeletal Med. 2016.
  11. Williams P, Trehan S, Tsouris N, Dines J, Dines D, Edward C, Gulotta L, Warren R. Functional Outcomes of Modular Conversion of Hemiarthroplasty or Total to Reverse Total Shoulder Arthroplasty.  HSS Journal. 2017.
  12. Wiser K, Borbas P, Ek E, Meyer D, Gerber C.  Conversion of Stemmed Hemi-or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design.  Clin Orthop Relat Res; 2015; 473:651-660.

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Zimmer, Inc.
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Warsaw, Indiana 46580
USA

Biomet Orthopedics
P.O. Box 587
56 E. Bell Drive
Warsaw, Indiana 46581-0587
USA

 

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