Prospective study of 50 Neer-II total shoulder arthroplasties in 44 patients at mean 3.5-year follow-up. Evaluated pain relief, range of motion, ADL function, and glenoid fixation durability across osteoarthritis, rheumatoid arthritis, and post-fracture diagnoses. Primary question: how reliable is unconstrained TSA, and what predicts glenoid component failure?
When you plan a total shoulder arthroplasty, the rotator cuff exam is not just about function — it determines whether a glenoid component will survive. This 1987 series established that every case of definite glenoid loosening occurred in the setting of a massive cuff tear, while no cases occurred with an intact or repairable cuff.
When you encounter a patient with end-stage glenohumeral arthritis and an irreparable massive cuff tear, this paper is why we think twice before placing a glenoid component. The biomechanical explanation is straightforward: without the cuff to center the humeral head, the deltoid drives superior migration, generating eccentric rocking forces that destroy the bone-cement interface.
The 74% glenoid radiolucency rate with cemented non-metal-backed polyethylene directly motivated subsequent implant design work, including metal-backed glenoids and refined cementation technique. Though metal-backed designs ultimately introduced their own failure modes.
For board purposes: flange-only lucent lines visible on immediate postop films are not clinically alarming. Keel lucent lines that are complete and greater than 2 mm with component shift indicate definite loosening and impending revision.
Prospective study of 50 Neer-II total shoulder arthroplasties in 44 patients at mean 3.5-year follow-up. Evaluated pain relief, range of motion, ADL function, and glenoid fixation durability across osteoarthritis, rheumatoid arthritis, and post-fracture diagnoses. Primary question: how reliable is unconstrained TSA, and what predicts glenoid component failure?
When you plan a total shoulder arthroplasty, the rotator cuff exam is not just about function — it determines whether a glenoid component will survive. This 1987 series established that every case of definite glenoid loosening occurred in the setting of a massive cuff tear, while no cases occurred with an intact or repairable cuff.
When you encounter a patient with end-stage glenohumeral arthritis and an irreparable massive cuff tear, this paper is why we think twice before placing a glenoid component. The biomechanical explanation is straightforward: without the cuff to center the humeral head, the deltoid drives superior migration, generating eccentric rocking forces that destroy the bone-cement interface.
The 74% glenoid radiolucency rate with cemented non-metal-backed polyethylene directly motivated subsequent implant design work, including metal-backed glenoids and refined cementation technique. Though metal-backed designs ultimately introduced their own failure modes.
For board purposes: flange-only lucent lines visible on immediate postop films are not clinically alarming. Keel lucent lines that are complete and greater than 2 mm with component shift indicate definite loosening and impending revision.