Wednesday, July 18, 2012

The Total Shoulder - its place in our practice today

One of my total shoulder patients, who is thrilled with her result, complained that this blog did not feature this procedure sufficiently. So here is the truth of the matter. When we review our records, we find that we perform almost exactly the same number of total shoulders per year as ream and run procedures. We have spent a lot of time studying the socket side of shoulder joint replacement to improve our approach to glenoid component insertion as shown here and here and here.  With these improved methods, we are observing faster recovery and anticipate a dramatically reduced rate loosening and wear in the long term follow-up study we have underway.

Here is the preoperative film of the left shoulder of an active golfer from a couple of states away. See the bone spurs below the joint and the lack of any space between his ball and his socket.

Here is the flattened humeral joint surface we say at surgery.

And here is the same shoulder after his total shoulder replacement. See the restoration of smooth surfaces on both sides of the joint. His high density polyethylene glenoid component occupies the dark space between his metal ball and the bone of the shoulder blade.

We offer this procedure with great confidence to those who want to have the greatest opportunity for a rapid recovery of comfort and function, as long as they do not plan activities with heavy impact (chopping wood, high level racquet sports, martial arts, weight lifting and the like). Individuals desiring heavy impact activities may be better served by a ream and run.

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