Integral surgical maneuvers in prosthetic shoulder arthroplasty

Total shoulder arthroplasty has advanced beyond addressing only the techniques of implant placement. To improve clinical results and assure maximum implant longevity, the surgeon needs to address soft tissue contractures, soft tissue deficiencies, glenohumeral instability, and bone deficiencies with a number and often a combination of surgical maneuvers. These techniques include excision of abnormal tissue, division of adhesions, selective tissue releases, variation in bone osteotomy or preparation to modify implant position, use of a variety of standard implants or custom devices, and supplementation of certain tissue deficiencies with autologous or allograft tissues. When the reconstruction is completed, the surgeon needs to assess movement, stability, and strength of the supporting tissues to plan an optimal rehabilitation program.