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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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Muito Obrigado