Evolution of shoulder arthroplasty

First Shoulder Arthroplasty

Although Jules Emile Péan is credited with performing the first shoulder arthroplasty, it was probably Themistocles Gluck who first recognized prosthetic replacement as a potential treatment option in the shoulder. Gluck, a Romanian who studied in Germany in the second half of the 19th century, pioneered joint replacement for the treatment of tuberculosis infection. Gluck reported on his design of an ivory shoulder replacement but never documented its use in a living human subject.

The first recorded shoulder arthroplasty was performed in 1893 by Péan, a Parisian surgeon who replaced the shoulder of a patient suffering from tuberculous arthropathy who had refused amputation. Péan implanted a shoulder prosthesis designed and constructed by J. Porter Michaels, a Parisian dentist; the prosthesis consisted of a rubber humeral head that had been boiled in paraffin to harden it and was attached to a platinum shaft via a metal wire. A second metal wire attached the implant to the glenoid. The patient initially “did well” after the surgery before ultimately requiring removal of the prosthesis for recurrence of infection 2 years later.

First-Generation Shoulder Arthroplasty

The first shoulder arthroplasty using a prosthesis with an anatomic design was performed in 1950 by Frederick Krueger. Krueger used a Vitallium implant created by molding proximal humeri obtained from cadavers. He successfully implanted this prosthesis in a young patient with osteonecrosis of the humeral head. The modern era of shoulder arthroplasty, however, was pioneered by Dr. Charles Neer. Neer originally performed hemiarthroplasty to treat complex proximal humeral fractures starting in 1953. Nearly 20 years later, he would report on the use of shoulder replacement for the treatment of glenohumeral arthritis. Neer originally used a monoblock implant; however, variations in humeral head size among patients led to the concept of modularity, which allowed the use of variable humeral head diameters in shoulder arthroplasty. Monoblock implants are now commonly referred to as first-generation shoulder arthroplasty.

Second-Generation Shoulder Arthroplasty

The introduction of modular humeral head arthroplasty with variable diameter gave rise to the second generation of shoulder arthroplasty. Although these designs appeared to be an improvement over the earlier monoblock designs, they did not seem to optimally fit all patients. Additionally, not all patients had the good and excellent clinical results reported by Neer after shoulder arthroplasty with first- and second-generation designs.