Scope Essentials 2024-Total Anatomic Shoulder Shoulder Arthroplasty

Video Transcription

Video Summary

This presentation reviews anatomic total shoulder replacement, covering its history, indications, surgical techniques, and outcomes. Dr. Neer pioneered shoulder replacement with hemiarthroplasty in 1951 and introduced the Neer II prosthesis with a glenoid component in 1973. Modern techniques emphasize precise restoration of the patient's anatomy with modular implants for better offset and alignment. Indications primarily include osteoarthritis with intact rotator cuff and minimal glenoid retroversion or subluxation; rheumatoid arthritis, avascular necrosis, and post-traumatic arthritis are secondary indications. Preoperative imaging focuses on MRI and selective CT for glenoid assessment. Glenoid morphology (A, B, C, D classification) and retroversion significantly affect outcomes, with excessive retroversion and subluxation leading to higher complication rates. Cemented or pegged components are used for glenoid fixation. Surgical technique involves careful soft tissue management, subscapularis peel, anatomic humeral head cuts, and optimal glenoid exposure. Long-term survivorship is generally good, but revisions after failure have poorer outcomes. Preservation of subchondral bone and proper glenoid positioning are key to success.

Asset Caption

Xinning (Tiger) Li, M.D.

Keywords

anatomic total shoulder replacement

Neer prosthesis

glenoid morphology classification

shoulder arthroplasty indications

surgical techniques for shoulder replacement