This early case series reports 22 Neer nonconstrained shoulder arthroplasties in rheumatoid and osteoarthritic patients. It compares hemiarthroplasty, total shoulder replacement, and a subacromial spacer technique. Minimum follow-up was two years (average four years, seven months).
When choosing between hemiarthroplasty and total shoulder replacement in an arthritic shoulder, remember why the glenoid matters. This series shows that a metal head left to articulate against native glenoid cartilage erodes it over years, producing late pain even when early function is good.
That is the mechanistic basis for resurfacing the glenoid when its surface is damaged, a principle still central to shoulder arthroplasty decision-making. The paper also reinforces that a nonconstrained design depends entirely on soft tissue. Repair the rotator cuff whenever possible, and use a subacromial spacer only when the cuff is truly irreparable, as in a rheumatoid patient with poor tissue.
Technically, preserve the deltoid origin to speed rehabilitation, resect the head in about 35° of retroversion, and screen for preoperative instability, since the one failure here was a posterior-inferior dislocation in an unstable shoulder.
This early case series reports 22 Neer nonconstrained shoulder arthroplasties in rheumatoid and osteoarthritic patients. It compares hemiarthroplasty, total shoulder replacement, and a subacromial spacer technique. Minimum follow-up was two years (average four years, seven months).
When choosing between hemiarthroplasty and total shoulder replacement in an arthritic shoulder, remember why the glenoid matters. This series shows that a metal head left to articulate against native glenoid cartilage erodes it over years, producing late pain even when early function is good.
That is the mechanistic basis for resurfacing the glenoid when its surface is damaged, a principle still central to shoulder arthroplasty decision-making. The paper also reinforces that a nonconstrained design depends entirely on soft tissue. Repair the rotator cuff whenever possible, and use a subacromial spacer only when the cuff is truly irreparable, as in a rheumatoid patient with poor tissue.
Technically, preserve the deltoid origin to speed rehabilitation, resect the head in about 35° of retroversion, and screen for preoperative instability, since the one failure here was a posterior-inferior dislocation in an unstable shoulder.