If I need a Total Shoulder Replacement what type of implant do you recommend?

The evolution of Arthroplasty designs since the 1st Total shoulder was designed by Dr Charles Neer has been extraordinary. The first generation of implants were essentially one piece----one size fits all. And both the humerus (stem) and glenoid implants were held in place with cement. Over time "modularity" has been worked into the designs in order to provide flexiblity; in other words, one size does not fit all.

Now, Dr Neer's results were very good with his relatively simple design, which means technique is still as important, if not more important, than the design. But, that having been said, we'd all probably agree that innovation over time improves design---and this translates into improved performance.

This has certainly been the case with golf clubs and skiis, and it's no different with shoulder arthroplasty designs.

Despite modularity (stem size and head size can be altered to fit the patient), not all implants currently used are truly "anatomic'. Some use a fixed neck shaft angle of 135 degrees, which means altering the cut despite what the patient's actual anatomy may call for in order to "replace like with like."

I use an anatomic prosthesis that utilizes a short stem (fixation is metaphyseal not at the tip of a longer stem), which does not require cement. It is  "press-fit", thus  bony ingrowth provides long term stability. I can match a patient's head size, neck-shaft angle, and offset. This presumably improves not only function but also durability.

 The glenoid has 3 peripheral pegs-- stabilized by a very small amount of cement, but definitive long-term faxation is provided by bony in growth into a central peg.

Copy and paste this link to see   2 articles at the bottom of the page which address the advancements accompanying this type of pegged glenoid: http://www.rearmyourself.com/article/anatomic-total-shoulder-replacement

You may see the early favorable outcome by clicking on the video at the bottom of the page mentioning the Tornier Ascend Implant or by copying and pasting this link:   http://www.rearmyourself.com/video/?v=/assets/lib/flash/Cummings%20outcome.flv

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