Forty year old man with severe arthritic deformity

 An active man with systemic lupus presented with pain and stiffness of his right shoulder. He could perform only four of the 12 Simple Shoulder Test functions with his right shoulder.

His x-rays showed collapse of the humeral head from avascular necrosis with secondary arthritis and humeral head deformity.

We discussed the options of a hemiarthroplasty and an anatomic total shoulder arthroplasty. At surgery, exposure was difficult - an in situ head cut was required to expose the humerus. Even after soft tissue releases, there was insufficient room in the joint for a glenoid component. The glenoid articular surface was smoothed with a curette. A standard length humeral stem was fixed with impaction autografting.

After surgery, we had difficulty regaining motion in spite of the patient's great efforts at therapy. Over the first year, three manipulations under anesthesia were carried out.

At 14 months after his procedure, he returned to have his opposite (left) side done. He was pleased with the comfort and function of his right shoulder and was able to answer "yes" to all 12 functions of the Simple Shoulder Test. The function of both shoulders is shown below.

His right shoulder x-rays at 14 months post op are shown below.

The preoperative films of his left shoulder are shown here.

A similar procedure is planned for this shoulder, anticipating the need for another major effort to regain his lost motion.

Comment: This case demonstrates a conservative surgical approach to a severely arthritic shoulder in a young patient. It showed us that post-arthroplasty manipulation(s) can be helpful in regaining motion of a shoulder that has been chronically stiff.

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link)

Shoulder arthritis - x-ray appearance (see this link)

The smooth and move for irreparable cuff tears (see this link)

The total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).