Anatomic Shoulder Arthroplasty: Technical Considerations

Abstract

Osteoarthritis of the shoulder is a common condition in the aging population, and it can have profound effects on patients' quality of life. The anatomic total shoulder arthroplasty is a well-described treatment modality resulting generally excellent outcomes. The objective of this review is to discuss the technical aspects of primary anatomic total shoulder arthroplasty, and to provide a framework to follow to achieve a successful surgical result. The topics covered include preoperative planning, surgical considerations, and approaches, humeral preparation, glenoid bone loss and the emerging concept of using the reverse total shoulder arthroplasty for the type B2 glenoid.

Keywords: Glenohumeral arthritis; Glenoid bone loss; Lesser tuberosity osteotomy; Midsubstance tenotomy; Reverse total shoulder arthroplasty; Subscapularis peel; Subscapularis-preserving; Total shoulder arthroplasty; Type B2 glenoid.

Fig. (1)

Graphic depicting the Friedman (red), scapula body (yellow) and intermediate (blue) line methods of determining scapular version. (Adapted from Rouleau DM, Kidder JF, Pons-Villanueva J, Dynamidis S, Defranco M, Walch G: Glenoid version: How to measure it? Validity of different methods in two-dimensional computed tomography scans. J Shoulder Elbow Surg 2010;19 [8]:1230-1237.).

Fig. (2)

Image depicting a type B2 glenoid (A) With three reference lines described by Walch: (B) The paleoglenoid, which represents the native glenoid version, (C) Intermediate glenoid, and (D) The neoglenoid, representing the new version of the glenoid. (Adapted from Rouleau DM, Kidder JF, Pons-Villanueva J, Dynamidis S, Defranco M, Walch G: Glenoid version: How to measure it? Validity of different methods in two-dimensional computed tomography scans. J Shoulder Elbow Surg 2010;19 [8]:1230-1237.).

Fig. (3)

Illustration depicting steps in glenoid bone grafting. (A) Glenoid with significant posterior erosion. (B) Preparation of the anterior glenoid. (C) Bone graft placement in deficient area, temporarily held in place with drills. (D) Replacement of the drills with 3.5 mm cortical screws. (Adapted from Steinmann SP, Cofield RH. Bone grafting for glenoid deficiency in total shoulder replacement. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons [et al] 2000;9:361-7.).