This document discusses different types of shoulder replacements, including hemi arthroplasty, total shoulder replacement, and reverse shoulder replacement. It notes that common reasons for shoulder replacements include osteoarthritis, rheumatoid arthritis, rotator cuff tears with secondary arthritis, fractures, and avascular necrosis. Total shoulder replacements involve replacing both the glenoid and humeral components, while reverse shoulder replacements reverse the positioning of the ball and socket. Reverse replacements have become more popular for treating irreparable rotator cuff tears with arthritis.

1. Shoulder Arthroplasty
Mr. Devinder Garewal
Orthopaedic Shoulder Surgeon

2. Orthopaedic terminology
• Hemi arthroplasty = replace half the joint
• Total joint replacement = replace entire joint
• Shoulder options:
• Hemi arthroplasty
• Total shoulder replacement
• Replace the ball and socket joint
• Reverse shoulder replacement
• Replace with a “reversed” ball and socket joint

3. Shoulder Replacements

4. Common pathology
• Osteoarthritis
• Rheumatoid arthritis
• Rotator cuff tear – with secondary arthritis
• Fracture
• Reduced blood supply to humerus (AVN)

5. Osteoarthritis

6. Cuff tear arthropathy

7. History
• First performed 1894
• Charles Neer was the pioneer of modern shoulder
replacements
• 1951: hemi-arthroplasty (for fractures)
• 1973: designed glenoid component to make first Total
Shoulder Replacement

8. Total Shoulder Replacement
• Replace glenoid with either:
• plastic (PE) which requires cement for fixation or
• a metal component that requires screws
• Replace humerus with stem/head (uncemented or cemented)
• Requires intact rotator cuff muscles to balance the shoulder
replacement and provide function to move the joint

9. PE glenoid

10. Metal back glenoid

11. Humeral stem

12. Total shoulder replacement

13. Reverse shoulder replacement
• Gained popularity over the last 15 years
• Increasing world wide use
• Glenoid and humeral components are reversed
• Relies on different muscles to provide function to the shoulder
• Deltoid
• Generally used in patients with irreparable rotator cuff injuries
in the setting of arthritis
• Difficult to salvage this replacement so reserved for elderly

14. Reverse shoulder replacement

15. Reverse shoulder replacement