Recognizing that the surgeon is the method, it is interest to view the outcomes of different approaches to anatomic total shoulder arthroplasty (ATSA).
The authors of Anatomic total shoulder arthroplasty for posteriorly eccentric and concentric osteoarthritis: a comparison at minimum 5-year follow-up present the average 8 year outcomes for a single-center series of 210 patients with refractory primary osteoarthritis treated with ATSA without attempt to correct glenoid version.
All cases were performed by one of three fellowship-trained shoulder surgeons. Preoperative 3D planning was not used for any of these cases.
All cases were performed by one of three fellowship-trained shoulder surgeons. Preoperative 3D planning was not used for any of these cases.
The shoulder was approached through the deltopectoral interval with a subscapularis peel. In cases with posteriorly eccentric wear, the humeral and glenoid sided capsular release during exposure was limited to the mid- sagittal plane (i.e. “6 o’clock”) to preserve posterior capsular tension. Glenoid reaming was limited to that necessary to create a single concavity, preserving bone stock without attempting to correct retroversion.
Sufficient reaming was indicated by the absence of tipping when a pegless, round-backed trial component was loaded eccentrically.
The glenoid component in the majority of cases utilized a fluted central peg for bone ingrowth with cemented peripheral pegs (Depuy-Synthes Anchor Peg; n = 204). Cementation technique involved meticulous drying with a pressurized carbon-dioxide spray
Particular attention was given to avoid cement on the backside of the implant.
A standard anatomic humeral arthroplasty was usually performed with conventional length stem (Depuy Global AP or Enovis Turon; n=204).
In cases in which excessive intraoperative posterior translation was identified with trial components in place, an anteriorly eccentric humeral head without or with rotator interval plication was considered to provide stability.
The outcome measures included the Simple Shoulder Test, radiolucencies around the glenoid component, and revisions.
98 (47%) of the shoulders had posteriorly decentered humeral heads while 108 (51%) had centered humeral heads.
77 shoulders had Walch type A glenoids and 122 had Walch type B glenoids.
35 shoulders had preoperative glenoid retroversion >15 degrees
The mean preoperative SST score of 3.4 improved to a mean of 9.4 at 8 years after surgery. Two patients (1%) underwent re-operations during the study period.
Neither the final SST, change in SST or percentage of maximal improvement were correlated with pre- and postoperative humeral head centering, Walch classification or glenoid version.
In patients with Walch B1 and B2 glenoids (n=110), there were no differences in outcome measures between patients with postoperative retroversion of more and less than 15 degrees.
While 15 of 51 patients (29%) with minimum 5-year radiographs had glenoid radioluciences, these radiographic findings were not associated with inferior clinical outcomes.
On multivariable analysis glenoid component radiolucencies were most strongly associated with incomplete component seating (bottom two images below).
Comment: This study indicates that clinically significant and durable outcomes with low revision rates can be accomplished with a straightforward surgical technique in which glenoid bone preservation is prioritized.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
