Recent experience in total shoulder replacement.

Publisher Website
Google Scholar
Abstract
A consecutive series of 273 shoulders treated with metal-to-plastic total glenohumeral units were reviewed. Nine sizes of humeral components and 5 different glenoid components, 2 of which were larger and more constrained, were used. The procedure is difficult and the technique varies according to the problems presented by each diagnostic category. Neither loss of bone nor a deficient rotator cuff is considered a contraindication to total glenohumeral repacement. Stability depends on the height as well as the version of the components. Function depends on meticulous reconstruction and rehabilitation of the rotator-cuff and deltoid muscles. Shoulders (194) which were followed for from 24-99 mo. were evaluated. Only 4 patients thought that they had not benefitted from the procedure. Radiolucent lines were seen at some part of the bone-cement interface of the glenoid component in 30% of those who were followed; the lines were thought to be due to faulty cementing technique in most patients. There was no instance of clinical loosening. There were 24 complications, of which 12 required further surgery. Of the 150 patients in the full exercise program, 129 (86%) achieved an excellent or satisfactory rating, and those with good muscles often had essentially normal motion and function. A so-called limited-goals rehabilitation category was delineated for the 20% of the patients in this series who had a massive deficiency of bone or muscle, and their results were graded separately. An investigation protocol was established to determine the value of a deep-socket semi-constrained glenoid component for use in the rare shoulder with a non-functioning rotator cuff. Although special soft-tissue surgical technique and individualized postoperative care are mandatory for optimum results, an unconstrained implant of this type, which approaches normal anatomy, will permit better function and endure longer in the shoulder joint than an implant with a fixed fulcrum.