Total Shoulder Replacement

- Discussion:
    - see shoulder replacement discussion (total shoulder vs hemiarthroplasty vs reverse arthroplasty)
    - the indications for total shoulder arthroplasty (versus hemiarthroplasty) are controversial;
           - there is some controversy regarding pain relief and component survivorship;
           - Gartsman GM, et al (2000), the authors compared hemiarthroplasty (24 shoulders) to TSR (27 shoulders);
                  - mean followup was 35 years;
                  - they noted significantly better pain relief and better internal rotation with total shoulder replacement;
                  - there was a trend for better patient satisfaction, function, and strength in TSR group; 
           - non concentric glenoid
                  - non-concentric glenoid (ie posterior glenoid erosion) is a clear indication for glenoid resurfacing, since a congruent joint is  necessary
                             for optimal function; 
    - references: 
           - Shoulder arthroplasty with or without resurfacing of the glenoid in patients who have osteoarthritis.
           - A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis.
           - Shoulder Arthroplasty with or without Resurfacing of the Glenoid in Patients Who Have Osteoarthritis 
           - Recentering the Humeral Head for Glenoid Deficiency in Total Shoulder Arthroplasty.
           - Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than five years of follow-up.

- Radiographs:
 
    - note the relation of the tuberosity and the humeral head (optimal to reproduce the vertical offset)
    - axillary view

- Surgical Technique:
    - surgical exposure
    - humeral preparation
    - glenoid component
    - trial reduction 
    - management of subscapularis - repair


- references:

- Influence of Preoperative Factors on Outcome of Shoulder Arthroplasty for Glenohumeral Osteoarthritis
- A comparison of hemiarthroplasty and total shoulder arthroplasty in the treatment of primary glenohumeral osteoarthritis: results of a multicenter study.
- A prospective functional outcome study of shoulder arthroplasty for osteoarthritis with an intact rotator cuff.
- Conversion of painful hemiarthroplasty to total shoulder arthroplasty: Long-term results
- Quality-of-life outcome following hemiarthroplasty or total shoulder arthroplasty in patients with osteoarthritis. A prospective, randomized trial.
- AAOS: Guidelines on the Treatment of OA
- Bilateral Anatomic Total Shoulder Arthroplasty Versus Reverse Shoulder Arthroplasty



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, August 31, 2015 9:08 am