Monday, August 7, 2017

Total shoulder - a conservative, bone-preserving approach

Two years ago a woman in her late 50's presented with pain in the right shoulder, an SST score of 5 out of 12, and these x-rays: 
Note the hooking osteophyte and the lack of joint space on the AP view

And the glenoid retroversion, biconcavity and posterior decentering on the the axillary 'truth' view.

She returned for her two year followup with an SST score of 12 out of 12 and these x-rays:

Note the preservation of the humeral bone stock, the stable fixation of the long stem achieved with impaction autografting, and the absence of stress shielding/bone resorption.
Note also the absence of radiolucent lines around the glenoid component, the absence of cement on the back side of the glenoid component, and the bone ingrowth between the flanges of the central peg of the glenoid component (arrow).

On the postoperative 'truth' axillary view, note again the bone ingrowth, the absence of back side cement, and the absence of radiolucent lines as well as the centering of the humeral head in the glenoid and the preservation of glenoid bone stock.

This technique provides a dependable, adaptable and bone-preserving approach to total shoulder arthroplasty.

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