Neer reports 273 consecutive total shoulder replacements performed 1973–1981 across seven diagnostic categories. The study defines which patients benefit most, establishes foundational surgical principles for component positioning, and introduces the limited-goals rehabilitation category for patients with massive muscle or bone deficiency.
Before this paper, constrained fixed-fulcrum shoulder prostheses were in use — Neer himself designed three types in 1972, then abandoned them by 1974 after recognizing they failed to restore external rotation and invited mechanical failure.
This series established that total shoulder replacement works because of the surgeon's hands, not the implant's geometry: cement the humerus at 30–40° retroversion with the head proud above the tuberosities, repair the cuff meticulously, and use the long deltopectoral approach that spares the deltoid origin.
When you see a patient with massive rotator cuff deficiency or significant bone loss being referred for shoulder replacement, do not reflexively decline. Counsel them that limited-goals rehab (90° elevation, 20° external rotation) is a legitimate, separately graded outcome that still provides meaningful pain relief and function for daily activities.
The observation that glenoid radiolucency is common (30%) but never caused clinical loosening in this series is foundational: it teaches that radiographic lucency alone should not drive revision decisions. Correlate with symptoms and component stability first.
Neer reports 273 consecutive total shoulder replacements performed 1973–1981 across seven diagnostic categories. The study defines which patients benefit most, establishes foundational surgical principles for component positioning, and introduces the limited-goals rehabilitation category for patients with massive muscle or bone deficiency.
Before this paper, constrained fixed-fulcrum shoulder prostheses were in use — Neer himself designed three types in 1972, then abandoned them by 1974 after recognizing they failed to restore external rotation and invited mechanical failure.
This series established that total shoulder replacement works because of the surgeon's hands, not the implant's geometry: cement the humerus at 30–40° retroversion with the head proud above the tuberosities, repair the cuff meticulously, and use the long deltopectoral approach that spares the deltoid origin.
When you see a patient with massive rotator cuff deficiency or significant bone loss being referred for shoulder replacement, do not reflexively decline. Counsel them that limited-goals rehab (90° elevation, 20° external rotation) is a legitimate, separately graded outcome that still provides meaningful pain relief and function for daily activities.
The observation that glenoid radiolucency is common (30%) but never caused clinical loosening in this series is foundational: it teaches that radiographic lucency alone should not drive revision decisions. Correlate with symptoms and component stability first.