Recent experience in total shoulder replacement

Abstract

Total shoulder replacement is a complex surgical procedure, which demands high surgical experience. A consecutive case-series of 273 shoulders managed by a total shoulder replacement in a single centre over an 8-year period is presented. Indications for surgery had been pain due to incongruity of the glenohumeral joint but was not limited to a single pathology. Twelve patients had had a constrained design of implant; in total 9 sizes of humeral component and 5 sizes of glenoid component had been inserted. The prosthesis design is near-anatomical allowing for minimal bone loss and good soft tissue reconstruction. Surgery was performed through variations of the delto-pectoral approach with the long delto-pectoral approach found to be the most effective. A meticulous repair of the soft tissue structures is needed to achieve good shoulder motion and stability. Follow-up showed excellent or satisfactory results at average 3 years in 171 of 194 shoulders. Twenty-four postoperative complications were observed, most commonly dislocation or rotator cuff tear with 12 patients needing further surgery for this. The excellent results of this series shows that an unconstrained total shoulder prosthesis is effective in most patients if surgery is performed with care taken with insertion of components and repair of soft tissue structures.