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Innovative Design Orthopaedics Ltd
6 Brewery Court
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Berkshire
RG7 5AJ
United Kingdom

 

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Key features of the Verso®

Stemless Prosthesis
avoids distal humeral canal reaming

Three-Finned Humeral Component

combines minimal bone resection with

secure cortical fit and rotational stability

‘Dial-able’ UHMWPE Liner

provides low medial edge,
reducing likelihood of notching and
improving rotational movement 

Tapered Glenoid Screw
for secure primary fixation

HA Coated Humeral and Glenoid Components
for enhanced secondary fixation

Entirely Modular System

matches all anatomy

Colour- and graphic-coded packages

for foolproof component selection

Verso Papers

 

Latest Paper in Journal of Shoulder and Elbow Surgery 2016
Excellent 2-7 years results with the Verso: 

Reverse shoulder arthroplasty with a cementless short metaphyseal humeral implant without a stem: clinical and radiologic outcomes in prospective 2- to 7-year follow-up study

 

Ofer Levy, MD MCh(Orth) FRCS*, Ali Narvani, FRCS (Tr&Orth), Nir Hous, MD, Ruben Abraham, FRCA, Jai Relwani, FRCS (Tr&Orth), Riten Pradhan, FRCS (Tr&Orth), Juan Bruguera, MD, PhD, Giuseppe Sforza, MD, Ehud Atoun, MD

J Shoulder Elbow Surg (2016) - ARTICLE IN PRESS http://dx.doi.org/10.1016/j.jse.2015.12.017

Verso paper in International Orthopaedics 2014:

 

Reverse shoulder arthroplasty with a short metaphyseal humeral stem

Ehud Atoun, Alexander Van Tongel, Nir Hous, Ali Narvani, Jai Relwani, Ruben Abraham, Ofer Levy
International Orthopaedics (SICOT), Published online 06 April 2014 

 

Excellent Verso® glenoid baseplate fixation  

- in a study comparing 6 different reverse shoulder designs at the Imperial College London: 
Primary stability in reversed-anatomy glenoid components
A R Hopkins and U N Hansen
Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 2009 223: 805

 

The Least complications with the Verso shoulder compared with other reverse shoulder systems

from the Royal National Orthopaedic Hospital, Birmingham, UK  
Complication rates from three commonly used reverse polarity total shoulder replacements: a minimum two year follow-up of 64 cases
S. Robati, M.K. Shahid, J. Allport, A. Ray and G. Sforza

Bone Joint J 2013 vol. 95-B no. SUPP 27 25

 

The Verso® total shoulder replacement design rationale and early results

Ofer Levy MD MCh(Orth) FRCS

Revised 2010 

The Verso total shoulder replacement was developed for use in severe rotator cuff deficient shoulders with arthritis.  Patients with cuff tear arthropathy or any other arthritic condition combined with severe cuff deficiency such as advanced rheumatoid arthritis, fracture sequelae and multiple failed surgery combined with severe rotator cuff deficiency.

Patients may suffer from antero-superior instability and antero-superior escape of the humeral head due to deficient rotator cuff and destructed coracoacromial arch.  These patients suffer from severe pain and limitation of movement and function.  They may have marked limitation in the function affecting even simple tasks of daily living such as taking care of their own hygiene, feeding themselves, getting dressed and undressed.  This lack of function can make the difference between a person being independent or needing 24/7 nursing. 

The treatment options for patients with this condition are very few.  Non-constraint conventional shoulder replacement; either resurfacing or stemmed hemiarthroplasty would provide them with pain relieve but no improvement of active motion and in cases of antero-superior escape will fail to improve their stability.  Bi-polar hemiarthroplasty will probably do the same.  The only option to improve these patients’ range of motion is by using a semi-constrained prosthesis with reversed geometry design, which allows the deltoid muscle to function better and improve the shoulder mobility.  All designs of reversed shoulder prosthesis in the 70’s have failed due to their excessive lateralisation of centre of rotation causing increased toque on the implant-bone interface of the glenoid component leading to glenoid loosening.  Professor Grammont’s idea of medialisation of centre of rotation towards the face of the glenoid and tensioning the glenoid muscle inferiorly has shown to be successful.

Reversed shoulder prostheses are gaining popularity in recent years.  Good mid-term results with restoration of active elevation have been reported.  However there is a high complication rate with a stemmed prostheses ranging between 24% to 50% in different series and many of them require further surgery.

Of major concerns are glenoid or humeral shaft fractures on preparation, dislocations and instability as well as high infection rate.  Glenoid notching is a serious complication that was noticed in over 70% cases with Grammont type of prosthesis  and seems to appear quite early at 2-3 months post operatively (Levigne et al., J Shoulder Elbow Surg 2008).  The amount of bone resected for the insertion of stemmed prosthesis make any further revision surgery very difficult and therefore the use is limited to the very elderly patients.

The Verso prosthesis – a novel different design of stemless, reversed geometry prosthesis with metaphyseal fixation and minimal bone resection, cementless and bone impaction fixation has been developed to overcome these concerns.  We have developed this prosthesis following extensive research since 1997 and it has been in clinical use since 2005.  The indications for the use of the Verso are in patients with glenohumeral arthritis and severe rotator cuff deficiency mainly;-

  1. Patients with rotator cuff arthropathy
  2. Fracture sequelae arthropathy with severe rotator cuff deficiency.
  3. Severe rheumatoid arthritis with dysfunctional or torn rotator cuff
  4. Severe cuff deficiency following multiple failed surgery with antero-superior escape
  5. Patient who had surface replacement arthroplasty which had deteriorated due to severe cuff deficiency can be revised to revere shoulder replacement.
  6. Patients with severe shoulder dysfunction following failed rotator cuff tear repair for massive cuff tears.
  7. Patients with stemmed shoulder replacement with severe cuff deficiency can be revised to verso total shoulder replacement either primary stemless prosthesis or stemmed verso prosthesis.
  8. Patients with facture nonunion of the proximal humerus with severe cuff deficiency can be treated with primary stemless verso or a stemmed verso prosthesis.

The rationale behind the design of the Verso was to create a simple yet sophisticated implant. When the implant and technique are simple, there are fewer places for errors.  Another principal is minimal bone resection and indeed the only bone that is resected in this procedure is the top end of the humeral head having a slice thickness of only 20mm. Even this bone is recycled and used for bone impaction.  Stemless, cementless fixation: there are only 3 thin fins which, combined with bone impaction technique gives immediate press fit fixation of the prosthesis to the humeral metaphysis and further biological fixation from the porous and hydroxyapatite coating. This design provides direct load transfer to the humeral metaphysis which greatly reduces stress shielding and proximal bone absorption.

To avoid the serious problem of glenoid notching the humeral shell liner was designed with a 10º angle ream which results in a low medial edge and available system to allow optimal position in each patient to avoid glenoid notching. 

The glenoid head is aimed slightly lower than the bottom edge of the glenoid bone and it is angled inferiorly at 5º thus reducing further to risk of glenoid notching. 

Rotational movements have been improved substantially compared with the other prostheses with the use of the dial-able 10º angle polyethylene liners and insertion of the humeral shell in 30º of retroversion. 

Revision and back up options were designed as well.  There is a revision-stemmed kit and a salvage kit, for cases where the glenoid has been fractured and the glenoid head cannot be implanted. This salvage kit comprises of a ‘mega head’, which is 2/3rds of a sphere that can be fitted on the humeral shell as “mega hemiarthroplasty”.  This will lateralise the centre of rotation and tension to deltoid muscle, and therefore, hopefully improve its function.  All options remain open for future surgery if deemed necessary as bone stock is preserved.  All the liners, glenoid heads, base plates and humeral shells are modular and interchangeable.

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