A 55 year old may presents with pain and stiffness in his left shoulder that came on after a stemless ream and run procedure performed almost two years prior. His pre ream and run film is shown below. Below is his postoperative film at the time of his presentation to us showing overstuffing related in part to a conservative head cut. On examination his active and passive flexion were limited to 30 degrees limited by extreme pain.   After discussion of the options, he decided to proceed with a revision ream and run arthroplasty after discussion of the risks and alternatives of ..read more

Ralph Waldo Emerson is credited with the saying, "build a better mousetrap and the world will beat a path to your door".  A similar sentiment may drive the marketing of many different types of glenoid components in anatomic shoulder arthroplasty. Almost all have a polyethylene surface for articulation with the humeral component. The difference lies in the mechanism for fixation to the bone of the glenoid. Below are a few of the many. One innovation uses porous metal into which bone can grow for fixation. The question is "does this innovation improve outcomes for patients?"   ..read more

We have found that stemless humeral components can work well with the ream and run procedure. Our experience has taught us that - even in this age of 3D CT planning and cutting guides - a well-done freehand cut yields precision and accuracy of humeral head position.  We preserve the biceps tendon, remove the anterior and inferior osteophytes, mark the superior margin of the articular surface (the "hinge point"), make the cut at 135 degrees with the shaft and in 30 degrees of retroversion while aiming the saw so that it exits the humerus just anterior to the posterior cuff insertion. Every ..read more

While the diagnosis of obvious shoulder infection is easy: the patient has local and systemic signs of inflammation, abnormal joint fluid and serum lab tests, and positive cultures for indisputable pathogens.  On the other hand, the diagnosis of a stealth shoulder infection is complicated: the most frequently implicated bacteria (Cutibacterium) is a commensal organism commonly isolated from normal skin, normal deep tissues and healthy shoulder joints. In a stealth infection the usual clinical evidence of infection is absent. A pragmatic definition of bacterial infection is "bac ..read more

The authors of Tendon stump type on magnetic resonance imaging is a predictive factor for retear after arthroscopic rotator cuff repair investigated the tear size, Goutallier stage, and global fatty degeneration index, seeking factors associated with retear after cuff repair. They also classified the rotator cuff tendon stump (yellow circle) by preoperative oblique coronal image plane T2-weighted fat-suppressed magnetic resonance imaging (MRI), comparing its signal intensity to that of the nearby deltoid muscle (red circle) in 305 patients having arthros ..read more

Randomization enables unbiased estimation of treatment effects; randomization attempts to assure that treatment-groups are balanced with respect to the important covariates. Unfortunately for us shoulder surgeons, surgical treatments are rarely assigned randomly. Propensity matching is an attempt to use observational data to compare two treatment groups by accounting for the covariates that are associated with the outcome.  The possibility of bias arises because a difference in the outcome between treatment groups may be caused by factors that predict which treatment the patie ..read more

 A 55 year old active man with limiting pain and stiffness of the left shoulder presented with these x-rays. Wishing to avoid the risks and limitations associated with the plastic glenoid component used in conventional total shoulder arthroplasty, he elected to proceed with a ream and run procedure. At followup 17 years after his procedure, he demonstrated excellent comfortable range of motion.  X-rays showed stable fixation of the impaction autografted humeral component along with healing of the reamed glenoid without evidence of wear. Comment: While glenoid erosion c ..read more

The concept of overstuffing in shoulder arthroplasty was introduced over 30 years ago (Practical Evaluation and Management of the Shoulder p181-184): "in many conditions requiring shoulder arthroplasty, the capsule and ligaments are contracted and therefore excessively limit the range of motion. Shoulder arthroplasty tends to further tighten the capsule because the degenerated humeral head is replaced by a larger one, and because a glenoid component is added to the surface of the glenoid bone, consuming more space than the degenerated cartilage it replaces. Thus, the components "stuff" t ..read more

Shoulder arthroplasty provides a great opportunity for patients with arthritis to recover lost shoulder comfort and function. However, recovery from the operation may challenge the patients' mental as well as their physical toughness. There is evidence that resilience may be an important attribute in the recovery from shoulder surgery. Several scales have been validated for assessing a person's resilience, including the Brief Resilence Scale and the The Connor-Davidson Resilience Scale, which assesses the ability to adapt to change, to deal with whatever comes, to see the&nb ..read more

The use of pyrocarbon as a bearing surface for shoulder hemiarthroplasty has attracted interest because of the theoretical advantages of increased smoothness and boundary lubrication. Some of the recent literature has been summarized in a recent post: Pyrocarbon shoulder hemiarthroplasty - what do we think we know? In vitro comparison of wear characteristics of PyroCarbon and metal on bone: Shoulder hemiarthroplasty examined the wear of cow femoral cortical bone when tested with pyrocarbon and cobalt chromium alloy hemiarthroplasty humeral heads in a wear simulator. How re ..read more