Preoperative planning is helpful in anticipating what might be needed to reconstruct an arthritic shoulder; however the final choice of implants is determined at the time of surgery.
A 43 year old man presented with pain and stiffness of his left shoulder. He had a prior CT scan showing an arthritic humeral head centered on a somewhat retroverted glenoid.
We obtained our standard set of plain radiographs: an AP in the plane of the scapula and an axillary "truth" view taken with the arm in a functional arm position of elevation. The truth view showed posterior decentering of the humeral head that was not evident on the CT scan taken with the patient's arm at his side. No 3D CT planning was used.
At surgery, a standard glenoid component was well seated after conservative glenoid reaming. "Corrective" reaming and a posteriorly augmented glenoid component were not used.
Trialing with an anatomic humeral head component revealed posterior instability when the arm was flexed forward. As a result, a short stemmed humeral component with an anteriorly eccentric humeral head was selected.
Postoperatively, his shoulder is clinically and radiographically stable when the arm is elevated to a functional position (as seen on the postoperative "truth" view).
Comment: This case illustrates (1) the value of the "truth" view before and after surgery and (2) the importance of tailoring implant selection based on intraoperative testing of motion and stability. NB: when we do an arthroplasty, the shoulder we have after soft tissue releases and osteophyte resection is different from the shoulder before surgery; that's why intraoperative assessment is more important than preoperative planning.
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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).
