An Overview of Advances in Shoulder Arthroplasty

Description

Anatomic total shoulder replacement patients frequently experience glenoid component loosening. Surgeons frequently utilise a pegged glenoid, is known about the radiographic or clinical outcomes. Recently, a study to describe the short-term radiographic and clinical outcomes has been reported.' Forty-one patients who had under-gone 44 total shoulder replacements were followed for 4 years clinically, the SST scores improved, because there was one problem due to the glenoid implant. The radiographic follow-up averaged 3 years. Bone ingrowth around the central peg, radiolucent lines, and appropriate seating were all checked in the glenoids. The occurrence of ingrowth around the central peg was linked to good component seating and preoperative glenoid deformity. The overall rate of perfect seating and central ingrowth was seen in 20/44 (45%) of the shoulder radiographs at the most recent follow-up. Lysis around the central peg was seen in 3/44 (7%) of the shoulders.

As previously stated, effective glenoid component implantation is dependent on implant stability and integration into the native bone. The use of patient-specific tools to assist glenoid preparation and implant may aid total shoulder surgery accuracy. The standard glenoid preparation technique was compared to the patient-specific instrument technique in 31 consecutive patients. Three-dimensional Computed Tomography (CT) software was used for preoperative planning. The primary outcome was a comparison of the preoperative and postoperative glenoid positions on CT. While the patient-specific instrument technique was more precise with less variation from the planned glenoid position as a group overall, the biggest benefit appeared to be in the patients that had more than 15° of glenoid retroversion. Perhaps if better methods for preparing the glenoid were used, the component could be positioned more precisely and offer better results. Because of continual concern about glenoid loosening, hemiarthroplasty for the treatment of shoulder arthritis remains popular. Several studies have found that patients who have had a whole shoulder replacement for arthritis had better pain reduction and function than those who used to have a hemiarthroplasty. Some people still believe that hemiarthroplasty is the same as total shoulder replacement. However, long-term hemiarthroplasty results have been documented with a prevalent outcome. Only 25% of patients were satisfied with their results at 17 years average follow-up. While the low level of satisfaction is common, the study suffers from a lack of a control group e.g. total shoulder cohort for comparison.

For the past few years, the treatment of the subscapular is during shoulder replacement has been a challenging issue in the shoulder field. Because it relies on bone-to-bone healing, can be monitored with plain radiographs, and has a better initial strength of repair than soft tissue repairs, the smaller tuberosity osteotomy has gained popular. The impact on clinical outcomes is now being studied. Lapner and his colleagues assigned patients to either an osteotomy or a subscapular is peel at the time of replacement and then evaluated them at a 2 year follow-up. Subscapular is strength and with various patient-centered outcome tools.' While 87 patients were initially randomized, there were 36 patients with osteotomies and 37 patients with subscapular are peels in the final analysis. The Improvements in shoulder arthroplasty implant design have turned some focus to long-term problems. The majority of patients who have a shoulder replacement for arthritis are elderly, making them more susceptible to rotator cuff issues.