Shoulder Arthroplasty. Raul Alonso T., Vicente Rivera

8/6/2019 Shoulder Arthroplasty. Raul Alonso T., Vicente Rivera

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Shoulder Arthroplasty

Raul Alonso T.

Vicente Rivera

Hospital Garcia de Orta, Almada - Portugal


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Evolution

First Shoulder Arthoplasty performed in 1853

(Frane - Dr. Jules Emil Pan)

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 ofsimilar materials in the shoulder. Neer II (1973)

1985 Reverse Proisthesis- Paul Grammont (Delta)


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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


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Unconstrained

Resurfacing: Partial or Humeral Head

Resurfacing.

Hemiarthroplasty.

Bipolar. Total arthroplasty.


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Hemiarthroplasty

Indicated for: Osteoarthritis, post-traumatic

arthritis, humeral head osteonecrosis-

Normal glenoid, humeral head centered (soft

tissues balance), adequated rotator cuff.


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Clinical case

Female, 66 years old.

Pain and severe functional disability (3 m)


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X-ray: Avascular necrosis- Intact

glenoidMRI: Good Rotator cuff


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1 year post-op


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1 year post-op


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Total Shoulder

Indications: Primary Orteoarthritis with

intractable pain. 50 years or older. Posteriorglenoid deficiency.

Importants points: Pre-op evaluation. History,

pysical examination, imaging. Pre-op planning

Deltopectoral appoach.


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Surgical Pearls

Subescapularis management is determined by

the amount of internal rotation contracturepresent pre-op.

Adequate glenoid exposure.

Soft tissue balancing is essential for

postoperative range of motion, function and

implant stability.


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Complications

Shoulder stiffness

Glenoid loosening

Posterior instability.


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Reverse Total Shoulder

Indications: irreparable rotator cuff

destruction. Unstable gleno-umeral joint.Functioning deltoid. Preserved glenoid

morphology. 70 years old or older. Low

activity.


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75 years old, female, R.A., rheumatoid

arthritis


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Reverse Total Shoulder


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80 years old. Osteoarthritis + Massive

rotator cuff tear. 5 months follow up


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Reverse Shoulder Improves biomechanics in cuff deficient

shoulders Restores the ability to actively raise de arm

Not as durable as unsconstrained TSA


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Conclusion Shoulder arthroplasty has been shown to

provide significant paint relief and improvementin overall function and patient satisfaction.

Results are disease specific.

A thorough preoperative evaluation, including ahistory, physical examination, and adequateimaging studies, allows for essential preoperativetemplating and may reduce intraoperative

complications. Complications can be reduced with proper

surgical technique and attention to detail.


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Shoulder Arthroplasty. Raul Alonso T., Vicente Rivera