Total shoulder arthroplasty for severe deformity

A 69 women presented with a rheumatoid arthritis, a history of long term steroid use, a painful stiff shoulder and these x-rays

She requested a total shoulder arthroplasty and had an excellent clinical result. Post operative films are shown below.

She then returned asking for 'the same' procedure on her right shoulder.

She could not be interested in a reverse total shoulder, even after extensive counseling about the severity of her pathoanatomy.

With some conservative sculpting of her glenoid, we were able to establish a secure, appropriately contoured glenoid bone surface onto which a standard glenoid component was secured. Sufficient glenoid bone stock remains for a reverse total shoulder should this reconstruction fail in the future.

Her postoperative x-rays are shown below.

Both shoulders are now comfortable and functional. We are following her recovery closely.

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The reader may also be interested in these posts:

Healing through joint replacement

Supporting progress in shoulder surgery

Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book.

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Information about shoulder exercises can be found at this link.

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You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

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Managing a humeral shaft deformity with a stemmed humeral component

We have found that a stemmed humeral component provides the most flexible and most secure approach to the humeral side of shoulder arthroplasty.

Even in the presence of a humeral shaft deformity, the combination of a relatively small diameter humeral stem and impaction grafting can enable the secure and properly oriented placement of the humeral articular surface.

As an example, here is the preoperative film of a man with a very tight shoulder and a prior history of fibrous dysplasia. We desired a thin broad humeral component ideally positioned with respect to his glenoid.

After soft tissue releases and resection of the osteophytes, impaction grafting was used to secure the thin-stemmed, short-necked humeral prosthesis in the desired position.

Comment: No humeral component fits the endosteal surface of the humerus as shown here.

Thus fixing of the component in the humerus requires either removing bone from the inside of the bone by broaching until a reasonable fit is achieved, cementing the prosthesis, obtaining a tight press fit in the diaphysis, bone ingrowth or impaction grafting. The latter is our preferred method because it adds, rather than removes bone, avoids the risk of fracture from a tight cortical press fit, avoids the use of cement, and avoids the difficulties associated with revision of an ingrowth prosthesis. As the prior post shows, impaction allografting can be used in revision of a prior failed arthroplasty.

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Consultation for those who live a distance away from Seattle.

Check out the new Shoulder Arthritis Book - click here.

Click here to see the new Rotator Cuff Book

To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.

To see other similar posts, click on the label of interest below.