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Instability and the Anatomic Total Shoulder Arthroplasty.

Adam J Seidl1, Stephen D Daniels

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Anatomic total shoulder arthroplasty instability affects 1-5% of patients. This review covers managing postoperative instability and preventing it during the initial surgery, especially for active patients.

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty
  • Shoulder Biomechanics

Background:

  • Anatomic total shoulder arthroplasty (aTSA) instability is a significant complication with a reported incidence of 1% to 5%.
  • Instability etiology is multifactorial, involving soft-tissue imbalance, bone pathology, or implant malposition.
  • Revision surgery for aTSA instability historically shows high failure rates, leading to increased use of reverse shoulder arthroplasty (RSA).

Purpose of the Study:

  • To review the current literature on managing postoperative instability following anatomic total shoulder arthroplasty.
  • To discuss intraoperative strategies for preventing instability during the index arthroplasty procedure.
  • To address the specific challenges of managing instability in young, active patient populations.

Main Methods:

  • Literature review of peer-reviewed articles on anatomic total shoulder arthroplasty instability.
  • Analysis of studies reporting on management strategies for postoperative instability.
  • Examination of research detailing preventative intraoperative techniques.

Main Results:

  • Instability in aTSA is complex, often resulting from combined factors.
  • While RSA offers stability, it may not be optimal for all patients, particularly younger, active individuals.
  • Preventative strategies during the index procedure are crucial for long-term success.

Conclusions:

  • Effective management of aTSA instability requires a thorough understanding of its causes.
  • Preventing instability during the initial surgery is paramount.
  • Tailoring treatment to patient-specific factors, especially in active populations, is essential for optimal outcomes.