Neer and colleagues reviewed how unconstrained metal‑to‑plastic total shoulder replacement performed across diagnostic categories, and which technical and rehabilitation factors governed stability and function.
Consecutive series of 273 shoulders, of which 194 were evaluated at 24 to 99 months.
Methods
Design
Prospective consecutive case series
1973 to 1981
Patients
273 shoulders in 249 patients
Bone loss and rotator cuff deficiency not excluded
Treatment
Unconstrained metal‑to‑plastic total shoulder (261 shoulders)
Semi‑constrained glenoid component (12 shoulders)
Nine humeral sizes and five glenoid components
Follow-up
194 shoulders evaluated
24 to 99 months (mean 37)
Outcomes
Excellent, satisfactory or unsatisfactory rating
Limited‑goals patients graded separately
Glenoid radiolucent lines
Complications and reoperations
Key Findings
In the full‑exercise rehabilitation group, 129 of 150 patients (86%) were rated excellent or satisfactory.
In osteoarthritis, 36 shoulders were excellent, 3 satisfactory and none unsatisfactory, with mean gains of 77° in active elevation and 51° in external rotation.
Among old‑trauma shoulders in the full program, 12 of 35 were unsatisfactory and mean elevation gain was only 33°.
Glenoid radiolucent lines appeared in 30% of followed shoulders, which the authors mostly attributed to faulty cementing, yet no shoulder loosened clinically.
Of 24 complications, 12 needed reoperation, and 4 implants dislocated in the first 3 weeks, all reduced closed.
The humeral component was cemented in 30 to 40° of retroversion, with the head set slightly above the greater tuberosity so the tuberosity would not impinge on the acromion.
Board pearl
Neer listed only two contraindications, infection and complete loss of both deltoid and rotator cuff function. Partial muscle weakness did not rule out replacement and instead changed the rehabilitation goals.
Authors' conclusion
Although special soft-tissue surgical technique and individualized postoperative care are mandatory for optimum results, we think that an unconstrained implant of this type, which approaches normal anatomy, will permit better function and endure longer in the shoulder joint than an implant with a fixed fulcrum.
Neer and colleagues reviewed how unconstrained metal‑to‑plastic total shoulder replacement performed across diagnostic categories, and which technical and rehabilitation factors governed stability and function.
Consecutive series of 273 shoulders, of which 194 were evaluated at 24 to 99 months.
Methods
Design
Prospective consecutive case series
1973 to 1981
Patients
273 shoulders in 249 patients
Bone loss and rotator cuff deficiency not excluded
Treatment
Unconstrained metal‑to‑plastic total shoulder (261 shoulders)
Semi‑constrained glenoid component (12 shoulders)
Nine humeral sizes and five glenoid components
Follow-up
194 shoulders evaluated
24 to 99 months (mean 37)
Outcomes
Excellent, satisfactory or unsatisfactory rating
Limited‑goals patients graded separately
Glenoid radiolucent lines
Complications and reoperations
Key Findings
In the full‑exercise rehabilitation group, 129 of 150 patients (86%) were rated excellent or satisfactory.
In osteoarthritis, 36 shoulders were excellent, 3 satisfactory and none unsatisfactory, with mean gains of 77° in active elevation and 51° in external rotation.
Among old‑trauma shoulders in the full program, 12 of 35 were unsatisfactory and mean elevation gain was only 33°.
Glenoid radiolucent lines appeared in 30% of followed shoulders, which the authors mostly attributed to faulty cementing, yet no shoulder loosened clinically.
Of 24 complications, 12 needed reoperation, and 4 implants dislocated in the first 3 weeks, all reduced closed.
The humeral component was cemented in 30 to 40° of retroversion, with the head set slightly above the greater tuberosity so the tuberosity would not impinge on the acromion.
Board pearl
Neer listed only two contraindications, infection and complete loss of both deltoid and rotator cuff function. Partial muscle weakness did not rule out replacement and instead changed the rehabilitation goals.
Authors' conclusion
Although special soft-tissue surgical technique and individualized postoperative care are mandatory for optimum results, we think that an unconstrained implant of this type, which approaches normal anatomy, will permit better function and endure longer in the shoulder joint than an implant with a fixed fulcrum.