#1 A man with a completely stiff shoulder and these preoperative X-rays.
No further imaging (i.e. no CT scan or 3D planning) was obtained. The most challenging part of this case was the soft tissue releases needed to safely expose the shoulder.
Post op x-rays show glenoid component inserted with minimal reaming, no version change, good seating and good cementing. Standard stem fixed with impaction grafting. Low filling ratio.
No brachial plexus block was used. Forward flexion to 130 post operative evening.
#2 A patient 7 years after a total shoulder performed at another hospital. Shoulder had not been comfortable since surgery and was painful on all motion. Preoperative x-rays show loose glenoid component.
At revision, the glenoid component was loose and worn. Frozen sections showed foreign body reaction.
The humeral and glenoid components were removed. The wound was thoroughly derided. The residual glenoid was smoothed. A new humeral component was fixed with impaction allografting.
No plexus block was used. Motion was started on the postoperative evening.
Comment: These cases show that straight forward approaches without complex technology can be used to address some of the challenges encountered in shoulder arthroplasty.
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