Glenoid baseplate positioning for reverse total shoulder replacements (rTSR) is key for stability and longevity. 3D planning and image-derived instrumentation (IDI) are techniques for improving implant placement accuracy. This is a single-blinded randomised controlled trial comparing 3D planning with IDI jigs versus 3D planning with conventional instrumentation. Eligible patients were enrolled and had 3D pre-operative planning. They were randomised to either IDI or conventional instrumentation; then underwent their rTSR. 6 weeks post operatively, a CT scan was performed and blinded assessors measured the accuracy of glenoid baseplate position relative to the pre-operative plan. 47 patients were included: 24 with IDI and 23 with conventional instrumentation. The IDI group were more likely to have a guidewire placement within 2mm of the preoperative plan in the superior/inferior plane when compared to the conventional group (p=0.01). The IDI group had a smaller degree of error when the native glenoid retroversion was >10° (p=0.047) when compared to the conventional group. All other parameters (inclination, anterior/posterior plane, glenoids with retroversion <10°) showed no significant difference between the two groups. Both IDI and conventional methods for rTSA placement are very accurate. However, IDI is more accurate for complex glenoid morphology and placement in the superior-inferior plane. Clinically, these two parameters are important and may prevent long term complications of scapular notching or glenoid baseplate loosening. Image-derived instrumentation (IDI) is significantly more accurate in glenoid component placement in the superior/inferior plane compared to conventional instrumentation when using 3D pre-operative planning. Additionally, in complex glenoid morphologies where the native retroversion is >10°, IDI has improved accuracy in glenoid placement compared to conventional instrumentation. IDI is an accurate method for glenoid guidewire and component placement in rTSA

In older patients (>75 years of age), with an intact rotator cuff, requiring a total shoulder replacement (TSR) there is, at present, uncertainty whether an anatomic TSR (aTSR) or a reverse TSR (rTSR) is best for the patient. This comparison study of same age patients aims to assess clinical and radiological outcomes of older patients (≥75 years) who received either an aTSR or a rTSA. Consecutive patients with a minimum age of 75 years who received an aTSR (n=44) or rTSR (n=51) were prospectively studied. Pre- and postoperative clinical evaluations included the ASES score, Constant score, SPADI score, DASH score, range of motion (ROM) and pain and patient satisfaction for a follow-up of 2 years. Radiological assessment identified glenoid and humeral component osteolysis, including notching with a rTSR. Postoperative improvement for ROM and all clinical assessment scores for both groups was found. There were significantly better patient reported outcome scores (PROMs) in the aTSR group compared with the rTSR patients (p<0.001). Both groups had only minor osteolysis on radiographs. No revisions were required in either group. The main complications were scapular stress fractures for the rTSR patients and acromioclavicular joint pain for both groups. This study of older patients (>75 years) demonstrated that an aTSR for a judiciously selected patient with good rotator cuff muscles can lead to a better clinical outcome and less early complications than a rTSR

The purpose of this study is to report the clinical and radiological outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up. After ethical approval (reference: 17/YH/0318), patients were identified and invited to participate in this observational study. Inclusion criteria included: 1) severe glenoid bone loss necessitating the need for custom implants; 2) patients with definitive glenoid and humeral components implanted more than 2 years prior; 3) ability to comply with patient reported outcome questionnaires. After seeking consent, included patients underwent clinical assessment utilising the Oxford Shoulder Score (OSS), Constant-Murley score, American Shoulder and Elbow Society Score (ASES), and quick Disabilities of the Arm, Shoulder, and Hand Score (quickDASH). Radiographic assessment included AP and axial projections. Patients were invited to attend a CT scan to confirm osseointegration. Statistical analysis utilised included descriptive statistics (mean and standard deviation) and paired t test for parametric data. 3 patients had revision surgery prior to the 2-year follow-up. Of these, 2/3 retained their custom glenoid components. 4 patients declined to participate. 5 patients were deceased at the time of commencement of the study. 21 patients were included in this analysis. The mean follow-up was 36.1 months from surgery (range 22–60.2 months). OSS improved from a mean 16 (SD 9.1) to 36 (SD 11.5) (p < 0.001). Constant-Murley score improved from mean 9 (SD 9.2) to 50 (SD 16.4) (p < 0.001). QuickDASH improved from mean 67 (SD 24) to 26 (SD 27.2) (p = 0.004). ASES improved from mean 28 (SD 24.8) to 70 (SD 23.9) (p = 0.007). Radiographic evaluation demonstrated good osseointegration in all 21 included patients. The utility of custom 3D-printed components for managing severe glenoid bone loss in primary and revision reverse total shoulder arthroplasty yields significant clinical improvements in this complex patient cohort

In patients with shoulder arthritis, the ability to accurately determine glenoid morphological alterations affects the outcomes of shoulder arthroplasty surgery significantly. This study was conducted to determine whether there is a correlation between scapular and glenoid morphometric components. Existence of such a correlation may help surgeons accurately estimate glenoid bone loss during pre-operative planning. The dimensions and geometric relationships of the scapula, scapula apophysis and glenoid were assessed using CT scan images of 37 South African and 40 Chinese cadavers. Various anatomical landmarks were marked on the 77 scapulae and a custom script was developed to perform the measurements. Intra-cohort correlation and inter-cohort differences were statistically analysed using IBM SPSS v28. The condition for statistical significance was p<0.05. The glenoid width and height were found to be significantly (p<0.05) correlated with superior glenoid to acromion tip distance, scapula height, acromion tip to acromion angle distance, acromion width, scapula width, and coracoid width, in both the cohorts. While anterior glenoid to coracoid tip distance was found to be significantly correlated to glenoid height and width in the South African cohort, it was only significantly correlated to glenoid height in the Chinese cohort. Significant (p<0.05) inter-cohort differences were observed for coracoid height, coracoid width, glenoid width, scapula width, superior glenoid to acromion tip distance, and anterior glenoid to coracoid tip distance. This study found correlations between the scapula apophyseal and glenoid measurements in the population groups studied. These morphometric correlations can be used to estimate the quantity of bone loss in shoulder arthroplasty patients

Abstract. Aim. Excessive glenoid retroversion and posterior wear leads to technical challenges when performing anatomic shoulder replacement. Various techniques have been described to correct glenoid version, including eccentric reaming, bone graft, posterior augmentation and custom prosthesis. Clinical outcomes and survivorship of a Stemless humeral component with cemented pegged polyethylene glenoid with eccentric reaming to partially correct retroversion are presented. Patients and Methods. Between 2010– 2019, 115 Mathys Affinis Stemless Shoulder Replacements were performed. 50 patients with significant posterior wear and retroversion (Walch type B1, B2, B3 and C) were identified. Measurement of Pre-operative glenoid retroversion and Glenoid component version on a post op axillary view was performed by method as described by Matsen FA. Relative correction was correlated with clinical and radiological outcome. Results. 4 were lost to follow up. 46 patients were therefore reviewed. The mean follow up was 4 years (2–8.9 years). Walch B1, Pre op Retroversion: 12 (8–20), post op retroversion :11.8 (−4 to 19), correction= 0.2. Walch B2, Pre op Retroversion :18.4 (10–32), post op retroversion: 13.2 (1 −22), correction= 5.2. Walch B3, Pre op Retroversion: 19.1 (13–32)post op retroversion : 16.1 (9–25), correction= 3.0. Walch C, Pre op Retroversion: 33.3 (28–42) post op retroversion: 16.0 (6–27), correction= 17.3. 3 patients required revision surgery for rotator cuff failure. Conclusion. Partial correction of glenoid retroversion with eccentric reaming and implantation of cemented pegged polyethylene component leads to satisfactory clinical outcomes at midterm follow up. No revisions for aseptic loosening of the glenoid were required

Pre-operative 3D glenoid planning improves component placement in terms of version, inclination, offset and orientation. Version and inclination measurements require the position of the inferior angle. As a consequence, current planning tools require a 3D model of the full scapula to accurately determine the glenoid parameters. Statistical shape models (SSMs) can be used to reconstruct the missing anatomy of bones. Therefore, the objective of this study is to develop and validate an SSM for the reconstruction of the inferior scapula, hereby reducing the irradiation exposure for patients. The training dataset for the statistical shape consisted of 110 CT images from patients without observable scapulae pathologies as judged by an experienced shoulder surgeon. 3D scapulae models were constructed from the segmented images. An open-source non-rigid B-spline-based registration algorithm was used to obtain point-to-point correspondences between the models. A statistical shape model was then constructed from the dataset using principal component analysis. Leave-one-out cross-validation was performed to evaluate the accuracy of the predicted glenoid parameters from virtual partial scans. Five types of virtual partial scans were created on each of the training set models, where an increasing amount of scapular body was removed to mimic a partial CT scan. The statistical shape model was reconstructed using the leave-one-out method, so the corresponding training set model is no longer incorporated in the shape model. Reconstruction was performed using a Monte Carlo Markov chain algorithm, random walk proposals included both shape and pose parameters, the closest fitting proposal was selected for the virtual reconstruction. Automatic 3D measurements were performed on both the training and reconstructed 3D models, including glenoid version, inclination, glenoid centre point position and glenoid offset. In terms of inclination and version we found a mean absolute difference between the complete model and the different virtual partial scan models of 0.5° (SD 0.4°). The maximum difference between models was 3° for inclination and 2° for version. For offset and centre point position the mean absolute difference was 0 mm with an absolute maximum of 1 mm. The magnitude of the mean and maximum differences for all anatomic measurements between the partial scan and complete models is smaller than the current surgical accuracy. Considering these findings, we believe a SSM based reconstruction technique can be used to accurately reconstruct the glenoid parameters from partial CT scans

Aims. To report early (two-year) postoperative findings from a randomized controlled trial (RCT) investigating disease-specific quality of life (QOL), clinical, patient-reported, and radiological outcomes in patients undergoing a total shoulder arthroplasty (TSA) with a second-generation uncemented trabecular metal (TM) glenoid versus a cemented polyethylene glenoid (POLY) component. Methods. Five fellowship-trained surgeons from three centres participated. Patients aged between 18 and 79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Patients were randomized intraoperatively to either a TM or POLY glenoid component. Study intervals were: baseline, six weeks, six-, 12-, and 24 months postoperatively. The primary outcome was the Western Ontario Osteoarthritis Shoulder QOL score. Radiological images were reviewed for metal debris. Mixed effects repeated measures analysis of variance for within and between group comparisons were performed. Results. A total of 93 patients were randomized (46 TM; 47 POLY). No significant or clinically important differences were found with patient-reported outcomes at 24-month follow-up. Regarding the glenoid components, there were no complications or revision surgeries in either group. Grade 1 metal debris was observed in three (6.5%) patients with TM glenoids at 24 months but outcomes were not negatively impacted. Conclusion. Early results from this RCT showed no differences in disease-specific QOL, radiographs, complication rates, or shoulder function between uncemented second-generation TM and cemented POLY glenoids at 24 months postoperatively. Revision surgeries and reoperations were reported in both groups, but none attributed to glenoid implant failure. At 24 months postoperatively, Grade 1 metal debris was found in 6.5% of patients with a TM glenoid but did not negatively influence patient-reported outcomes. Longer-term follow-up is needed and is underway. Cite this article: Bone Jt Open 2021;2(9):728–736

Aims

The objective of this study was to compare simulated range of motion (ROM) for reverse total shoulder arthroplasty (rTSA) with and without adjustment for scapulothoracic orientation in a global reference system. We hypothesized that values for simulated ROM in preoperative planning software with and without adjustment for scapulothoracic orientation would be significantly different.

The results of revision TSA do not historically match the results of primary TSA. This is especially true if the diagnosis is a soft tissue related problem that leads to the revision. When a revision TSA is considered in this setting, instability is the major problem to overcome and a reverse TSA is most often needed. In the past this would require that the glenoid and humeral components be removed. Some manufacturers have produced shoulder prosthetic systems that can be converted to a reverse TSA without removing the humeral stem making the revision surgery potentially easier for both the patient and the surgeon. The data bank from two academic shoulder services were utilised to compare outcomes of revision TSA with and without removing the humeral stem at the time of revision surgery. Sixty-seven patients were identified in which 22 did not have the stem removed and 45 required the stem to be revised. The pre-operative and post-operative data for 1 and 2 years were available. Codman's scores, range of motion, estimated blood loss, time in the operating room, complications and cost of the implants were evaluated. The average blood loss was 280 cc vs. 500 cc, 145 minutes vs. 211 minutes, constant scores were 32 pre-op and 75 post-op vs. 32 pre-op and 70 post-op, complications 0 vs. 9 and the cost of the implants were 23% more in the stem removal group. The results of revision TSA do not match the results of primary arthroplasty. The results of not having to remove the humeral stem when doing a revision arthroplasty vs. using a system that has to remove both components has certain advantages. The overall outcome score are similar, however, the complication rate, blood loss, time in the operating room and cost of the implants are significantly less

The modern humeral head resurfacing was developed by Stephen Copeland, M.D. and introduced in 1986 as an alternative to stemmed humeral implants. At the time, first and second generation monoblock and modular stems with non-offset humeral heads posed many challenges to the surgeon to recreate the pre-morbid humeral head anatomy during anatomic TSA. The consequences of non-anatomic humeral head replacement were poor range of motion, increased native glenoid or glenoid component wear and premature rotator cuff failure. Additionally, the early generation humeral stems were very difficult to extract when revision was needed. The original stemless devices were cup resurfacing implants that were designed based on the early hip experience. The Copeland resurfacing device offered the ability to better match native humeral head anatomy and was considered less invasive and easier to revise. Glenoid exposure required more extensive dissection but TSA could be successfully completed. Clinical results for motion, function and outcome scores are similar to stemmed implants. The survivorship of the implants is also on par with other available implants and loosening has not been an issue. Stress shielding is not reported. Multiple manufacturers offered similar products all designed to try to predictably recreate the pre-morbid anatomy and to make insertion easier. Critical review of resurfacing arthroplasty radiographs has raised concern about the challenges of placing the implant with proper sizing and position. Most surgeons have implanted resurfacing implants as hemiarthroplasties. The development of anatomic TSA implants has allowed surgeons to better recreate the normal pre-morbid anatomy of the humerus. Newer stem designs are convertible or easily removable. This counters many of the original design benefits of resurfacing. The primary reason for revision of resurfacing implants is malposition followed by glenoid arthrosis and rotator cuff failure. Revision surgery after resurfacing has had mixed results. Stemless implants were introduced in Europe 13 years ago. Stemless devices share the benefits of resurfacing as minimally invasive and easier to revise. The added benefit of better glenoid access allows the surgeon to implant a glenoid. Most available implants have minimal follow-up. Mid-term follow-up of one design has demonstrated good fixation and loosening is uncommon. No studies are available that critically evaluate the surgeon's ability to recreate normal pre-morbid anatomy, whether revision arthroplasty is bone preserving and if results of revision will improve

The treatment of patients with arthritis of the glenohumeral joint with an associated massive irreparable cuff tear is challenging. Since these patients usually have proximal migration of the humerus, the CTA extended head allows a surface with a low coefficient of friction to articulate with the acromion. Between 2001 and 2006 a total of 48 patients with arthritis of the shoulder joint associated with a massive cuff tear, were treated with a CTA head. The indications for use being Seebauer Type 1a and 1b appearances on x-ray and active abduction of the arm to more than 60° with appropriate analgesia. Preoperatively, a Constant score and an ASES pain and function score were completed as well as standard radiological assessment. These were repeated at follow up. Paired t tests were carried out for all the variables. A Kaplan-Meier survival analysis was performed. Follow up varied between 2 and 8 years. Improvements in pain, function and all movement parameters were significant at p< 0.001. There was no change in the strength component. Survival analysis showed 94% survival at 8 years (95% CL 8%) there were 2 revisions and 5 deaths. Radiological assessment at follow up revealed no evidence of humeral stem loosening. In 5 (17%) cases however there was evidence of erosion in the surface of the acromion and in 13 (45%) erosion of the glenoid. Finally one component was also seen to have subluxed anteriorly. This head design has been in use for a number of years. To date there appears to be no reported outcome of their use. This series shows that in an appropriately selected patient a satisfactory clinical outcome can be maintained in the short to medium term. The presence of erosion of the glenoid but also the under surface of the acromion does require continuing monitoring

Purpose: Despite good clinical results of the reverse total shoulder arthroplasty inferior scapular notching remains a concern. The aim of this study was to evaluate the effect of 6 different parameters on notching. Materials and Methods: An average shape A-P view 2-D computer model of scapula was created, using data from 200 scapulae, so that the position of the glenoid and humeral component could be changed, as well as design features such as depth of the polyethylene insert, size of glenosphere and centre of rotation. The model calculates the maximum adduction (notch angle). Results: A change in humeral neck shaft inclination from 155° to 145° resulted in a gain of 10° in notch angle. A change in cup depth from 8mm to 5mm resulted in a maximum gain of 12°. With no inferior prosthetic overhang a lateralisation of the centre of rotation from 0 to 5mm resulted in a maximum gain of 15° on notch angle. More lateralization resulted in increased gain in notch angle. With an inferior overhang of only 1 mm no effect of lateralizing the centre of rotation was calculated. Glenoid varus of 0 to 10°, without inferior overhang, results in a gain of 10° on notch angle. A change in glenosphere radius from 18 to 21mm resulted in no gain of notch angle without prosthetic overhang. A prosthetic overhang to the bone from 0 to 5mm results in a maximum gain on notch angle of 39°. Conclusion: To prevent an inferior scapular conflict in reverse total shoulder arthroplasty the change in neck-shaft angle or depth of the polyethylene insert had a modest gain in notch angle. The effect of lateralization of the centre of rotation and putting the glenosphere in more varus was completely eliminated by adding a small inferior overhang. The main effect of increasing the size of the glenosphere was if it created a prosthetic overhang. Of all 6 tested parameters the prosthetic overhang resulted in the biggest gain in notch angle and this should be considered when designing the reverse arthroplasty and defining optimal surgical technique

Purpose:. The optimal degree of conformity between the glenoid and humeral components in cemented total shoulder arthroplasty (TSA) has not been established. Glenoid component stability is thought to be at risk due to the “rocking-horse” phenomenom, which, can lead to increased micromotion and loosening in response to humeral head edge loading. The goal of this biomechanical study is to investigate the influence of glenohumeral mismatch on bone-implant interface micromotion in a cemented glenoid implant model. Methods:. Twenty-Five cemented glenoid components (Affiniti, Tornier, Inc., Bloomington, MN, USA) were implanted in polyurethane foam biomechanics testing blocks. Five glenoid sizes, 40 mm, 44 mm, 48 mm, 52 mm and 55 mm (n = 5 per glenoid size), were cyclically tested according to ASTM Standard F-2028-08. A 44 mm humeral head (Affiniti, Tornier, Inc., Bloomington, MN, USA) was positioned centrally within the glenoid fixed to a materials testing frame (MTS Mini-Bionix II, Eden Prairie, MN, USA). Phase I testing (n = 3 per glenoid size) involved a subluxation test for determination of the humeral head translation distance which would be used for phase II cyclic testing. During cyclic loading, the humeral head was translated ± distance for 50,000 cycles at a frequency of 2 Hz, simulating approximately 5 years of device use. Glenoid compression, distraction, and superior-inferior glenoid translation were measured throughout testing via two differential variable reluctance transducers. Results:. Humeral head translation distance was identified as 0.55 mm, 1.09 mm, 2.32 mm, 3.82 mm, and 4.73 mm for each glenoid size, respectively (Figure 1). No significant difference was noted in 40 mm glenoids between cycle 1 and 50,000 for all parameters evaluated during testing (p > 0.05) (Figure 2). Conversely, a significant decrease in superior-inferior translation was present for 44 mm between cycle 1 and 50,000 (p = 0.010) (Figure 3). When analyzing all data from the first two smallest glenoid sizes, glenoid compression and translation both showed significantly increased micromotion with 40 mm glenoid sizes compared with the 44 mm glenoid size (p = 0.010 and p = 0.002, respectively). No significant difference was found with respect to glenoid distraction (p = 0.136). Conclusion:. The first phase of mechanical testing established the subluxation displacement of the humeral head against the glenoid for each prosthetic mismatch couple, which was larger for couples with greater glenohumeral mismatch. During cyclic testing, this displacement distance was covered in the same amount of time leading to differences in humeral head velocity and resultant stresses seen at the implant-cement-foam interfaces. A smaller mismatch in glenohumeral radius may lead to greater stress with shorter humeral translation compared to greater mismatch allowing for larger translations with lower resultant stresses. Data from our study will provide further clarification on the importance of glenohumeral mismatch on implant stability. Further studies are warranted to fully evaluate the impact and optimal amount radial mismatch for a clinical setting

INTRODUCTION: The reverse DELTA III shoulder prosthesis can successfully relieve pain and restore function in cuff tear arthropathy. The most frequently reported complication is inferior scapular notching. The purpose of this study was to evaluate the clinical relevance of notching and to determine the anatomic and radiographic parameters that predispose to its occurrence. STUDY PROTOCOL: Seventy-seven consecutive shoulders of 76 patients of an average age of 71 years with an irreparable rotator cuff deficiency were treated with a reverse DELTA III shoulder arthroplasty and followed clinically and radiographically under fluoroscopic control for a minimum of 24 months (mean: 44, range: 24 to 96). The effect of glenoid cranial caudal component positioning and of the prosthesis–scapular neck angle on the development of inferior scapular notching and clinical outcome was assessed. RESULTS: All shoulders which developed notching did so in the first fourteen months. Forty-four percent of the shoulders had inferior scapular notching, 30% had posterior notching and anterior notching (8%) was rare. Osteophytes along the inferior scapula occurred in 27% of the shoulders. The angle between the glénosphère and the scapular neck (r=+0.677)) as well as the craniocaudal position of the glénosphère (r=+0.654) were highly correlated with inferior notching (p< 0.001). A notching index (notching index = height of prosthesis + (prosthesis scapular neck angle x 0.13) was calculated using the height of implantation of the glénosphère and the postoperative prosthesis scapular neck angle: This allowed a prediction of the occurrence of notching with a sensitivity of 91% and specificity of 88%. The height of implantation of the glenosphere had a greater influence on inferior notching than the prosthesis scapular neck angle by a factor of approximately 1:8. Inferior scapular notching was associated with a significantly poorer clinical outcome than absence of inferior notching: At final follow-up, the respective average subjective shoulder values were 62% and 71% (p=0.032), relative Constant scores were 72% and 83% (p=0.028), abduction strength was 4.3 versus 8.7 kilograms (p< 0.001), active abduction was 102° versus 118° (p=0.033) and flexion averaged 110° versus 127° (p=0.004). DISCUSSION: Inferior scapular notching after reverse total shoulder arthroplasty adversely affects midterm clinical outcome. It can be prevented by optimal positioning of the glenoid component

Aims

It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on complication and reoperation rates, shoulder outcome scores, and comparison of anatomical and reverse prostheses when used in revision surgery.

Purpose: Loosening of the humeral component is rarely a cause for revision shoulder surgery. Most long-term series are not large enough to stratify the many risk factors that might influence the survivorship of humeral component designs. The purpose of this study was to determine long-term survivorship of the Neer and Cofield humeral components and to define the risk factors associated with humeral component removal or revision. Method: 1584 primary Neer and Cofield shoulder arthroplasties (1423 patients) were performed at our institution from 1984 to 2004. There were 619 men (694 shoulders) and 804 women (890 shoulders), with a mean age at arthroplasty of 65.6 years (range, 16–94 years). Kaplan-Meier survivorship analysis was used to determine the effect of etiology of the disease, gender, age, surgery type (hemi versus total), fixation type (cemented versus noncemented), and the humeral component type (Neer II, Cofield I or II) on the estimated survival free of humeral component revision or removal. Results: There were 108 revisions and 17 removals of the humeral component. The overall rate of removal or revision of the humeral component was 7.9% with an average followup of 8.1 years. The rates of survivorship free of revision or removal of the humeral component for any reason was 94.8% at 5 years, 92% at 10 years, 86.7% at 15 years and 82.8% at 20 years. Seventy-one of 632 shoulders (11.2%) in patients younger than 65 years required humeral component revision or removal, whereas only 54 of 952 shoulders (5.7%) in patients 65 years and older required humeral component revision or removal (Odds ratio=2.1; 95% confidence interval, 1.5–3, p=0.001). Patients with posttraumatic arthritis had a higher risk of needing revision or removal of the humeral component (Odds ratio=2.1, 95% confidence interval 1.3–3.3) compared to osteoarthritis. Eighty-four of 526 shoulders (16.0%) with metal-back glenoid components required humeral component revision or removal, whereas only 41 of 1058 shoulders (3.9%) with non metal-backed glenoid components required humeral component revision or removal (Odds ratio=4.7; 95% confidence interval, 3.2–7, p=0.001). Conclusion: Younger age, replacement due to post-traumatic arthritis and presence of a metal-backed glenoid increased the likelihood of humeral component failure. Similar short-term survival can be achieved with Cofield II and Neer II humeral components

Arthroplasty implant modularity enables the surgeon to adapt the joint replacement construct to the patient's requirements, and often facilitates revision procedures. Total shoulder arthroplasty humeral modularity exists for many implant systems. Glenoid modularity with convertibility between anatomic and reverse shoulder arthroplasty is a recent development. Glenoid modularity is very useful when reconstructing glenoid bone deficiencies, or in providing a method for reverse shoulder arthroplasty joint lateralization. The live surgery will demonstrate a bio-reverse total shoulder arthroplasty (bRTSA). The humeral component is a modular press fit stem that can accommodate either reverse or anatomic metaphyseal components. The metaphyseal components can be exchanged without removing the stem or changing the humeral height. The glenoid base has three components. The trabecular titanium peg is available in two diameters, and four lengths for each diameter. The peg is fixed to a metal base plate via Morse taper. In revision settings, these components can be easily dissociated in situ, and a coring drill inserted over a well-fixed peg allows removal with minimal bone loss. Either a polyethylene component, or glenosphere can be attached to the baseplate to complete the glenoid construct. An innovative set of instruments have been developed to reliably prepare the glenoid and humeral bone graft. While the live surgery will demonstrate the grafting technique in a bRTSA, it can also be used to reconstruct glenoid deficiencies (eg, Walch B2). Implants have been developed to solve these issues, but often do so at the expense of very limited glenoid bone stock. Bone grafting actually creates a net increase in glenoid bone stock that may improve implant durability, and decrease revision complexity. The technique is quite simple and adds approximately ten minutes to operative time. I have used this technique for 5 years with no cases of graft failure

Intra-operative complications vary from extremely benign such as glenoid vault penetration to life and limb threatening for example brachial artery injury. Most intra-operative complications can be avoided with careful pre-operative planning, anticipation, and execution. However, even the best planning and execution including fluoroscopic guided reaming cannot prevent all complications. The following intra-operative complications will be discussed in detail in regards to both prevention and management: Glenoid vault penetration, Glenoid component malposition - reverse and primary, Glenoid fracture - reverse and primary, Humeral component malposition - reverse and primary, and Humeral fracture - reverse and primary

Aims

The Mathys Affinis Short is the most frequently used stemless total shoulder prosthesis in the UK. The purpose of this prospective cohort study is to report the survivorship, clinical, and radiological outcomes of the first independent series of the Affinis Short prosthesis.

The incidence of total shoulder arthroplasty continues to increase. The most common reason for failure of a total shoulder arthroplasty is the glenoid component. Two styles of cemented all-polyethylene components are commonly implanted. These two styles are pegged glenoid and keel glenoid components. Data regarding the superiority of the styles has focused on radiolucent lines, complete loosening and need for revision procedures. Several retrospective and randomised controlled trials have been published to examine these endpoints. There is a trend in the literature to demonstrate decreased rates of radiolucent lines with pegged glenoid components, but a recent systematic review of available trials did not demonstrate a significant difference in the rate of radiolucent lines between the two styles. A slightly increased rate of revision was noted for the keel components. Overall pegged and keel glenoids both still represent good options in total shoulder arthroplasty