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Results and complications

The results of unconstrained shoulder arthroplasty for fracture have been reported by multiple investigators. The overall results have been very disappointing and are not comparable with those obtained for chronic conditions such as primary osteoarthritis. The advances in unconstrained arthroplasty implants and techniques for fracture described in this section have greatly improved the results. Fortunately, results from reverse shoulder arthroplasty for fracture are promising, with improved…

Humeral prosthetic positioning

Humeral prosthetic positioning remains the most difficult step in performing unconstrained humeral head arthroplasty or reverse shoulder arthroplasty for fracture. Placing the humeral component excessively proud or in excessive retroversion may result in loss of fixation and subsequent migration of the greater tuberosity ( Figs. 29.1 and 29.2 ). The complication of tuberosity migration has been found to be a key factor in poor results after…

Preoperative planning and imaging

Preoperative planning is important for all shoulder arthroplasty indications, but it is most crucial for fracture cases. Although proximal humeral anatomy may be somewhat distorted by prolonged wear and osteophyte formation in cases of chronic disease for which shoulder arthroplasty is performed, most reliable anatomic landmarks remain consistent despite the disease process. In fracture cases, however, these normally reliable landmarks are often displaced, thus making them…

Indications and contraindications

The use of unconstrained humeral head replacement or reverse shoulder arthroplasty in cases involving acute fracture represents perhaps the most difficult indication for shoulder arthroplasty. Patients who are candidates for arthroplasty after proximal humeral fracture tend to be older, with age-related osteopenia. Complications, both systemic and shoulder-specific, are more common in this patient population than in patients undergoing unconstrained and reverse shoulder arthroplasty for chronic conditions.…

Results and complications

Reports on the results of reverse shoulder arthroplasty are becoming more common as implantation of this type of shoulder arthroplasty increases. The results vary predominantly by the underlying indication for which the arthroplasty was performed. The results and complications presented in this chapter are drawn from our experience with this implant over the last 20 years, including the lead author's early experience in Europe. Results The…

Glenoid component

Unlike cases of unconstrained shoulder arthroplasty, in which placement of a glenoid component is optional, the glenoid component must be placed during reverse shoulder arthroplasty. As in unconstrained arthroplasty, adequate glenoid exposure is paramount in placement of the glenoid component; this is covered in Chapter 20 . Many different implant companies are now manufacturing reverse-design shoulder prostheses. The glenoid components of the various brands generally consist…

Preoperative planning and imaging

Reintroduction of the reverse-design prosthesis has allowed surgeons to treat complicated shoulder pathology for which no good solution existed before availability of this implant. The severity and diversity of shoulder pathology treatable with a reverse prosthesis make preoperative planning even more important in these cases than with primary unconstrained shoulder arthroplasty. Candidates for a reverse prosthesis may include patients with substantial proximal humeral or glenoid bone…

Indications and contraindications

Reintroduction of reverse-design shoulder arthroplasty has added a powerful device to the shoulder surgeon's armamentarium. Reverse ball-and-socket shoulder prostheses were initially introduced in the 1960s to treat patients with glenohumeral arthritis and massive rotator cuff tears. The concept of these and subsequent devices is to resolve upward migration of the humeral head and thereby restore the normal deltoid moment arm. This allows the deltoid to power…

Results and complications

The results of unconstrained shoulder arthroplasty have been reported by multiple investigators. These results vary predominantly according to the underlying indication for which the arthroplasty was performed. To our knowledge, the largest reported database of results of unconstrained shoulder arthroplasty was presented in Nice, France, in 2001. Because of the large number of patients enrolled, this multicenter study has allowed meaningful conclusions to be drawn about…