Decision making in glenohumeral arthroplasty.

Prosthetic replacement arthroplasty for glenohumeral arthritis is a well-developed and well-described technique with good and excellent results. The surgeon is faced with many decisions to make, however, regarding choice of implant, implant fixation, soft tissue management, and options for glenoid resurfacing. In general, when the precise cause of the arthritic condition is identified, the choices become more straightforward. For advanced osteoarthritis of the shoulder joint in an older patient with asymmetric posterior erosion of the glenoid, a total shoulder arthroplasty renders the best relief of pain and improvement in motion. Similarly, for advanced rheumatoid arthritis in patients with an intact rotator cuff, a total shoulder arthroplasty results in the best pain relief. If the rotator cuff is deficient and irreparable, an anatomically sized humeral head replacement is appropriate, taking care to preserve the coracoacromial arch. Acute, nonreducible fractures of the proximal humerus are treated best with a humeral head replacement. Post-traumatic arthropathy of the shoulder joint is treated with arthroplasty, and the decision to resurface the glenoid should take into account the age of the patient and the wear and concentricity of the glenoid. Many options exist for the choice of an implant; biomechanical and anatomic studies suggest that a better technical result can be achieved with a third-generation implant design that has the ability to recreate accurately the proximal anatomy of the humerus. Copyright 2003, Elsevier Science (USA). All rights reserved.