Abstract
Management of arthropathy of the glenohumeral joint has undergone an evolution from neglect to arthrodesis to arthroplasty over the past 30 years. Indications for total shoulder arthroplasty include severely symptomatic glenohumeral arthritis resulting from rheumatoid arthritis, osteoarthritis, a variety of inflammatory arthropathies, post-traumatic arthritis, chronic or multiple recurrent dislocation arthropathy, cuff tear arthropathy and even septic arthritis.
Each form of arthropathy has its own special indications and nuances regarding the successful performance of arthroplasty. With good bone stock and a healthy soft tissue envelope (comprised of deltoid, scapula support musculature and rotator cuff tendons), resurfacing of both the proximal humerus and glenoid has proven to be a very successful surgical procedure, affording reduction in pain, improved motion and function. This procedure has undergone an evolution from the early prosthesis designed by Dr. Charles Neer to the many modular prosthetic devices now available, providing the capability to closely resemble native anatomy in the form of size, version, and angulation. Although the prostheses themselves focus on the restoration of articular surfaces, the key to a successful operation lies in the appropriate tensioning of the soft tissues and recreation of a functional dynamic soft tissue envelope. When bone stock is limited (most commonly involving the glenoid or the glenoid neck), hemiarthroplasty with or without fascial resurfacing of the glenoid has been shown to be helpful.
In cuff deficient patients mobilisation and transfer of tendons around a hemiarthroplasty to provide stability and limited motion has proven to be a good alternative to total shoulder replacement. In the face of infection, debridement and staged reconstruction using an antibiotic impregnated methacrylate spacer with later exchange for a hemi- or total shoulder arthroplasty has been a successful solution and alternative to arthrodesis. Resection arthroplasty and/or arthrodesis are rarely indicated in the active individual but may prove to be viable “bail out” procedures in the patient with chronic infection, low demand or deltoid paralysis.
Arthroscopic debridement of a moderately arthritic joint in young patients has recently been described but its long-term efficacy and has yet to be demonstrated.
Participants should take away from this session an understanding of the indications and contraindications for total shoulder arthroplasty as well as appropriate alternatives in a variety of challenging clinical entities.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
