Anatomical total shoulder replacement in glenohumeral osteoarthritis : Indications, current implants, and clinical results

Abstract

Within the last 50years, implants for shoulder replacement have developed rapidly. Monobloc-stems in few sizes were changed to modular implant systems that allow for an individual adaption of the stem, as well as adaption of the humeral head component according to the specific anatomic situation of the patient. Moreover, stemless und short stem implants are available, which may highly simplify primary implantation, especially in posttraumatic cases as well as in revision cases with a need for removal or change of the implants. Concerning the glenoid component, cemented PE-inlays were further modified to increase long-term survival rates. Moreover, cement-free modular "metal-backs" allow for aconversion to areverse total shoulder arthroplasty without removal of the "metal back" component. Long-term survival rates of total shoulder arthroplasties achieve comparable survival rates to knee and hip arthroplasties with good to excellent clinical long-term results. In addition to an experienced surgeon, the key to asuccessful surgical result is the correct and timely indication, as massive contractures of the soft tissues as well as excessive abrasion of the glenoid bone may significantly impair the functional results.