Robert Cofield distills five decades of open shoulder surgery experience at Mayo Clinic into technical and clinical lessons. Drawing on registry data, he quantifies outcomes for rotator cuff repair, glenohumeral instability, and shoulder arthroplasty that case-by-case impression alone could not reliably detect. This is a capstone reference piece, not a primary study — its value is in the crystallized decision thresholds and technique principles.
Registry data changed what Cofield thought he knew from clinical impression alone. The 8% revision rate looked equal between hemiarthroplasty and TSA, but the registry revealed they fail for completely different reasons — glenoid arthrosis pain for hemi vs. Loosening and wear for TSA.
When you are deciding between hemi and TSA in a marginal case, lean toward TSA: the hemi will eventually cause pain from progressive glenoid wear, and that pain is harder to revise than a loose glenoid component.
For any patient with a periprosthetic shoulder infection workup, hold cultures for at least 14 days. Cutibacterium acnes is now the dominant organism, grows slowly, and is missed on standard 5-day cultures.
Tell patients after shoulder arthroplasty that arm motion returns in the first 6 months, but strength will still be only about 70-75% of normal at one year. Undersetting expectations on strength recovery leads to unnecessary patient dissatisfaction.
Robert Cofield distills five decades of open shoulder surgery experience at Mayo Clinic into technical and clinical lessons. Drawing on registry data, he quantifies outcomes for rotator cuff repair, glenohumeral instability, and shoulder arthroplasty that case-by-case impression alone could not reliably detect. This is a capstone reference piece, not a primary study — its value is in the crystallized decision thresholds and technique principles.
Registry data changed what Cofield thought he knew from clinical impression alone. The 8% revision rate looked equal between hemiarthroplasty and TSA, but the registry revealed they fail for completely different reasons — glenoid arthrosis pain for hemi vs. Loosening and wear for TSA.
When you are deciding between hemi and TSA in a marginal case, lean toward TSA: the hemi will eventually cause pain from progressive glenoid wear, and that pain is harder to revise than a loose glenoid component.
For any patient with a periprosthetic shoulder infection workup, hold cultures for at least 14 days. Cutibacterium acnes is now the dominant organism, grows slowly, and is missed on standard 5-day cultures.
Tell patients after shoulder arthroplasty that arm motion returns in the first 6 months, but strength will still be only about 70-75% of normal at one year. Undersetting expectations on strength recovery leads to unnecessary patient dissatisfaction.