Total Shoulder Design Innovations Advance Outcomes

[mtomaino]

Total Shoulder Replacement has come a long way since it was originally introduced. For years the humeral replacement imitated the femoral component of a total hip, and similar to early designs for that joint--one size fit all. There was no such thing as "modularity", thus patients with different anatomy received the same implant. Dial forward to 2010 and innovations in total shoulder designs have addressed variations in anatomy. When it comes to the shoulder, this means size of head and glenoid, neck inclination, version and offset. Indeed, though intuitive, functional outcomes do improve when the "replacement" replicates the patient's "pre-arthritis" anatomy.

The newest designs have shortened the stems--reflecting our understanding that fixation is mostly metaphyseal-not from the stem. This results in less pain and less blood loss. Newer glenoid replacements rely less on cement (albeit a small amount is used in 3 short pegs) and more on bony in growth into a central peg. Operating times have shortened from 3 hours to less than two.

I have attached three xray pictures below. These include the newest generation "short stem" with pegged glenoid implant, a more conventional humeral implant, and a typical xray showing glenohumeral osteoarthritis.

I have attached a link to a video showing early outcome with the Tornier Ascend prosthesis (1st x-ray below). Click on the link:http://www.rearmyourself.com/video/?...%20outcome.flv

or click on: http://www.rearmyourself.com/article...er-replacement

and play the video at the bottom entitled "Early Favorable Outcome using the Tornier Ascend Anatomic Total Shoulder Prosthesis." The video shows actual bony ingrowth into the peg!! We are hopeful that this biologic advance will improve the durability of the glenoid component and result in a much lower incidence of loosening over the years.