Shoulder arthrodesis and resection arthroplasty.

The indications for shoulder arthrodesis are changing, with paralysis from brachial plexus injuries and sepsis with cartilage loss now accounting for most of the cases. Intra-articular fusion methods, often combined with incorporation of the acromion into the fusion mass, are now the favored techniques. Fusion can be consistently accomplished (between 90% and 95% of patients) with the use of screws, but additional internal fixation with a plate can eliminate the need for prolonged cast treatment after operation. A range of arm positions is satisfactory, with positioning in abduction from 20 to 45 degrees, flexion 20 to 45 degrees, and internal rotation 30 to 60 degrees. After shoulder fusion, pain is usually but not always relieved and function is limited, especially in activities that require arm rotation. Resection arthroplasty has a long history. It is no longer used as a primary procedure. After surgery, stability is usually achieved, active abduction will be less than 90 degrees, and only one half to two thirds of patients will experience satisfactory pain relief. Current indications are essentially limited to salvage after an infected shoulder implant or failed total shoulder arthroplasty with extensive bone loss.