Total shoulder arthroplasty -- current problems and possible solutions

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Materials Science

Background:

• Total shoulder arthroplasty (TSA), pioneered 25 years ago, is a successful treatment for degenerative and inflammatory shoulder conditions.
• Clinical outcomes are significantly influenced by pathology severity, surgeon expertise, and component placement.
• TSA is technically demanding, posing a higher risk of errors and complications compared to other joint replacements.

Purpose of the Study:

• To review the current state and evolution of cemented unconstrained total shoulder arthroplasty (TSA) designs.
• To discuss the factors influencing clinical outcomes and long-term complications.
• To highlight advancements in component design and fixation for improved functional recovery and survivorship.

Main Methods:

• Review of current literature and established practices in total shoulder arthroplasty.
• Analysis of component design evolution, including modularity and fixation techniques.
• Discussion of common complications, such as aseptic glenoid loosening, and their contributing factors.

Main Results:

• Modern TSA systems feature modular humeral components for precise fit and joint line positioning.
• Cemented all-polyethylene glenoid components with increased curvature are favored, though aseptic loosening remains a concern.
• Evolving designs focus on enhanced modularity for humeral components, aiming for better functional recovery and glenoid component survivorship.

Conclusions:

• Advancements in TSA design, particularly humeral component modularity, aim to optimize soft tissue balance and functional outcomes.
• Addressing glenoid component fixation and wear remains critical for long-term success.
• Continued innovation in TSA is expected to improve patient function and implant survivorship.