Shoulder Arthroplasty

Raul Alonso T.
Vicente Rivera
Hospital Garcia de Orta, Almada - Portugal
 Evolution
• First Shoulder Arthoplasty performed in 1853
(Françe - Dr. Jules Emil Péan)
• 1953 Charles S. Neer II designed his prosthesis.
Building in concepts he learned from the
treament of humeral neck fractures.
• Charnley succes with low-friction metal on high-
density polyethilene prompted interest the use of
similar materials in the shoulder. Neer II (1973)
• 1985 Reverse Proisthesis- Paul Grammont (Delta)
 Surgical Options
• Constrained, semi-constrained and
unconstrained.
• Most standard arthopasty systems:
Unconstrained.
• Semi-constrained: few remain in use.
• Constrained systems: rotator cuff deficient
arthritic shoulder.
• Modularity: more reliable re-creation of
humeral anatomy
 Unconstrained
• Resurfacing: Partial or Humeral Head
Resurfacing.
• Hemiarthroplasty.
• Bipolar.
• Total arthroplasty.
 Hemiarthroplasty
• Indicated for: Osteoarthritis, post-traumatic
arthritis, humeral head osteonecrosis-
• Normal glenoid, humeral head centered (soft
tissues balance), adequated rotator cuff.
 Clinical case
• Female, 66 years old.
• Pain and severe functional disability (3 m)
X-ray: Avascular necrosis- Intact
glenoid
MRI: Good Rotator cuff
1 year post-op
1 year post-op
 Total Shoulder
• Indications: Primary Orteoarthritis with
intractable pain. 50 years or older. Posterior
glenoid deficiency.
• Importants points: Pre-op evaluation. History,
pysical examination, imaging. Pre-op planning
• Deltopectoral appoach.
 Surgical Pearls
• Subescapularis management is determined by
the amount of internal rotation contracture
present pre-op.
• Adequate glenoid exposure.
• Soft tissue balancing is essential for
postoperative range of motion, function and
implant stability.
 Complications
• Shoulder stiffness
• Glenoid loosening
• Posterior instability.
 Reverse Total Shoulder
• Indications: irreparable rotator cuff
destruction. Unstable gleno-umeral joint.
Functioning deltoid. Preserved glenoid
morphology. 70 years old or older. Low
activity.
• 75 years old, female, R.A., rheumatoid
arthritis
Reverse Total Shoulder
80 years old. Osteoarthritis + Massive
rotator cuff tear. 5 months follow up
 Reverse Shoulder
• Improves biomechanics in cuff deficient
shoulders
• Restores the ability to actively raise de arm
• Not as durable as unsconstrained TSA
 Conclusion
• Shoulder arthroplasty has been shown to
provide significant paint relief and improvement
in overall function and patient satisfaction.
• Results are disease specific.
• A thorough preoperative evaluation, including a
history, physical examination, and adequate
imaging studies, allows for essential preoperative
templating and may reduce intraoperative
complications.
• Complications can be reduced with proper
surgical technique and attention to detail.
Muito Obrigado