Abstract
The key to management of instability when performing total shoulder arthroplasty is to recognise the potential for instability, and avoid the pitfalls which may lead to it post-operatively. Instability can result from incompetent capsular or rotator cuff soft tissue envelopes. It may also result from muscular imbalances, as well as incompetent bony architecture (severe posterior wear causing extreme retroversion, or anterior glenoid loss from fracture) extreme retroversion or improper placement or fixation of implants.
Keys to providing a stable environment include performing careful soft tissue releases and providing muscular balance about the reconstructed arthroplasty; placement of implants in proper version; appropriate tensioning (height) and sizing (avoiding undersizing or overstuffing) of implants; recognizing incompetent rotator cuff substance or function and providing more stable, constrained implants (reverse total shoulder arthroplasty), when necessary.
Keys to recognizing potential instability, tips and pearls for intra-operative and post-operative surgical management will be provided.
