Return to sport after shoulder arthroplasty for post fracture deformity

Today we received this email from a woman treated three years ago for a post fracture proximal humeral deformity

The hemiarthroplasty was performed with an impaction grafted humeral body and a posteriorly eccentric humeral head to manage the posterior offset of her malunited fracture.

 Three years after surgery she reports on her participation in the Alaskan International Senior Games: "Well worth the 640 mile drive! The Diehards, plus 2 spouses, have a medal total of 20. And the good news is I'm "aging up" next year into the 70-74-years-old category, so my developing sprint running talent will do even better. I'm not a fast swimmer, but my 100-yard backstroke, the true test of well-functioning shoulders, got me a gold. And before we left, I found a bronze medal in a scrapbook my mother kept for me. It was inscribed: "AAU shotput 1965." Fifty-three years later I got a silver medal in the shotput, and I'm still improving. Thanks again, so great to be able to depend on that shoulder! Thinking of the national games next."

This is only part of the story of this highly motivated woman, who is also a pianist, flutist, and Zumba instructor.

Comment: This is yet another example of the use of a basic solution to a potentially complex problem.

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Shoulder arthroplasty with anterior glenoid bone deficiency - augmented glenoid or posteriorly eccentric humeral head?

Total shoulder arthroplasty with an augmented component for anterior glenoid bone deficiency.

These authors present 5 patients having total shoulder arthroplasty using an anteriorly augmented glenoid component. The preoperative diagnoses were anterior glenoid erosion in 2 patients, and 1 patient each with malunited glenoid fracture, nonunited glenoid fracture, and post-traumatic arthritis. The mean age at the time of surgery was 67.4 years (range, 53-75 years).

At an average of 33.2 months (range, 21.9-43.2 months) after surgery no patient had demonstrated radiographic or clinical signs of glenoid component loosening or instability. 

Comment: Anterior glenoid erosion predisposes the shoulder to anterior instability. As shown in this figure from the paper, it can usually be identified on a standardized axillary x-ray.

These authors have reported the use of an augmented glenoid component in the management of five such shoulders with durable results.

An alternative approach is to use a posteriorly eccentric humeral head component with a standard glenoid component accepting the glenoid anteversion as shown in the case below. This approach preserves the maximal amount of glenoid bone stock.

The posteriorly eccentric humeral head component has also improved useful in the management of failed arthroplasty with anterior glenoid bone deficiency, again accepting the anteversion of the glenoid.

The posteriorly eccentric humeral head can also manage post traumatic deformity in which the head is posteriorly malunited.

And one final case posted along with post surgical video showing the functional level achieved.

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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'

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