Development of Proprioception After Shoulder Arthroplasty

Abstract

Since the introduction of shoulder arthroplasty in 1893 by the French surgeon Jule-Emile Pean [18], the indications for shoulder replacement have expanded. Today shoulder arthroplasty is a common treatment for glenohumeral osteoarthritis [2]. Shoulder arthroplasty can significantly improve the function of osteoarthritic shoulders [7, 13, 19, 27]. Comparing the results, TSR offers better shortand mid-term results, but has the risk of long-term problems as the glenoid loosening [2]. In our practice patients with glenohumeral osteoarthritis will receive a total shoulder arthroplasty. As an exception patients with osteoarthritis which is limited to the humeral head without eccentric erosion of a stable sclerotic glenoid (Typ A1 glenoid according to Walch [28]) can be treated with hemiarthroplasty (HA). If the glenoid shows eccentric posterior wear (> A1), a TSR is recommended. The use of total shoulder replacement in the setting of rotator cuff-tear arthropathy (CTA) has led to poor outcomes because of early glenoid implant failure [17]. These failures were the result of early glenoid loosening caused by altered biomechanics in the cuff-deficient shoulder. The treatment of choice for most used to be hemiarthroplasty. Although good relief from pain has usually been obtained, most patients with CTA and subsequent hemiarthroplasty had a limited range of movement, leading to difficulties with the activities of daily living. These poor results let to the development of the reverse shoulder prosthesis, as a new method for treating CTA. Using the reverse prosthesis in CTA, favorable outcomes have been reported [15, 17]. In order to use the replaced shoulder for ADLs the concerted function of the active stabilizers and the passive restraints of the replaced shoulder joint is necessary.