Shoulder Replacement

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What is shoulder replacement and its goal?
Shoulder replacement is a complex surgical procedure that involves replacing the shoulder joint with prosthetic implant. Shoulder replacement is a complex surgical procedure that involves replacing the shoulder joint with prosthetic implant.

What leads to shoulder replacement?

  • Arthritis
  • Fractured or broken shoulder.
  • Avascular Necrosis

What is the diagnosis?

  • X-Rays
  • CT Scan,
  • Magnetic Resonance Imaging (MRI)
  • EMG Test, Or
  • Nerve Conduction Test

What are the types of replacement and resurfacing?
Total shoulder replacement (traditional shoulder arthroplasty)
Sometimes called traditional shoulder replacement or traditional shoulder arthroplasty, this surgery replaces the original ball-and-socket surfaces of the shoulder with similarly shaped prosthetic.It is used for treating shoulder arthritis.

Reverse shoulder replacement (reverse total shoulder arthroplasty)
The surgeon reverses the position of shoulder joints ball and socket.the positions of the shoulder joint's ball and socket. At the humerus,the ball is replaced while the shoulder's natural socket is fitted with a prosthetic ball. It is used for patients whose damaged rotator cuffs make them ineligible for traditional shoulder replacement.

Partial shoulder replacement (stemmed hemiarthroplasty)
In shoulder hemiarthroplasty, the arm's humeral head is removed and replaced with a prosthetic ball but the natural socket is kept.

  • Ream and run. During this version of a partial shoulder replacement surgery, the natural socket is kept; however, the surgeon might use special tools to smooth and reshape this socket to facilitate better shoulder joint movement. This process is called a hemiarthroplasty with non-prosthetic glenoid arthroplasty or, "ream and run."

Shoulder Resurfacing (resurfacing hemiarthroplasty)
The damaged humeral head is fitted with a rounded cap to provide a better joint movement.. Resurfacing does not require the complete removal of the natural humeral head nor the insertion of a prosthetic humeral stem.

What are the types of implants?
There are many different types of implants that are used for an anatomic shoulder replacement. They all share the same basic components: a metal ball that rests against a plastic (polyethylene) socket. In a reverse shoulder these components, while still metal and plastic, are “reversed”, the metal ball is attached to the patient socket, and the plastic socket is attached to the upper humerus.

The polyethylene socket is often cemented to the bone surrounding it, so that fixation to the bone is immediate. The prosthetic ball has a stem that is usually placed inside the humerus without the need for cement.

A new implant, The Comprehensive Primary Shoulder System, with a ball made of cobalt chrome and a stem made of titanium metal, featuring modular (separate) components; the ball, stem, and socket all fit together to provide a more customized fit. The ball component features Versadial, which allows for the new humeral head to be “dialed in” to conform to the patient’s exact anatomy, and the stem was designed to be cementless, providing the opportunity for the ingrowth of bone into the prosthesis.
The socket also features a metal peg permitting native bone to grow into the implant.

What are the recent advances?
Suture anchors
Suture anchors have undergone remarkable changes over time, and the newer designs have focused on greater load to failure strength, ease of insertion, and ability to accommodate multiple sutures. The most recent innovations address the issue of potential revision surgery.

Bioabsorbable suture anchors
Suture anchors basically function to attach soft tissues to bone; they were initially made of metal, but lately have been replaced by bioabsorbable suture anchors. Bioabsorbable fully threaded suture anchors provide higher pull out strength in poor quality bone. The fully threaded design also prevents anchor pull back as seen in countersunk design.

Bioabsorbable materials
Composed of Poly L-lactic acid (PLLA) and β-tricalcium phosphate (β-TCP) have better osteoconductive and bioreabsorbable qualities leading to early bone formation. Polyether ether Ketone (PEEK) is another thermoplastic material used in suture anchors with excellent stability and biocompatibility.

Knotless double row repairs
The use of fully threaded anchors and forming a knotless construct using two anchors medially and two lateral locks can provide a low profile secure fixation with increased tendon to bone contact. Bioabsorable sutures with titanium tip allows direct push in technique of suture insertion minimizing the need to prepare a bone channel for the lateral row, where soft tissue can sometimes obscure the view.

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