Skip to main content

Advertisement

SpringerLink
Log in

Soft tissue balancing in total shoulder replacement

  • Shoulder: Modern Techniques in Reconstruction (A Babhulkar, Section editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Total shoulder arthroplasty is now capable of recreating near anatomic reproduction of native bony shoulder anatomy, but the function and longevity of anatomic shoulder replacement is dependent on a competent soft tissue envelope and adequate motoring of all musculo-tendinous units about the shoulder. Balancing the soft tissues requires understanding of the anatomy and pathology, as well as technical skills. The advent of reverse shoulder biomechanics has brought with it special requirements of understanding of the soft tissue elements still left in the shoulder despite major rotator cuff deficiency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Rasmussen JV, Olsen BS, Fevang BT, Furnes O, Skytta ET, Rahme H, et al. A review of national shoulder and elbow joint replacement registries. J Shoulder Elbow Surg. 2012;21:1328–35. doi:10.1016/j.jse.2012.03.004. National Joint Registries will provide significant data for future claims both positive and negative regarding shoulder arthroplasty survivorship.

  2. Carter MJ, Mikuls TR, Nayak S, Fehringer EV, Michaud K. Impact of total shoulder arthroplasty on generic and shoulder-specific health-related quality-of-life measures: a systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012;94:e127. doi:10.2106/JBJS.K.00204.

    Article  PubMed  Google Scholar 

  3. Burroughs PL, Gearen PF, Petty WR, Wright TW. Shoulder arthroplasty in the young patient. J Arthroplasty. 2003;18:792–8.

    Article  PubMed  Google Scholar 

  4. Denard PJ, Raiss P, Sowa B, Walch G. Mid- to long-term follow-up of total shoulder arthroplasty using a keeled glenoid in young adults with primary glenohumeral arthritis. J Shoulder Elbow Surg. 2013;22:894–900. doi:10.1016/j.jse.2012.09.016. National Joint Registries will provide significant data for future claims both positive and negative regarding shoulder arthroplasty survivorship.

  5. Merolla G, Bianchi P, Lollino N, Rossi R, Paladini P, Porcellini G. Clinical and radiographic mid-term outcomes after shoulder resurfacing in patients aged 50 years old or younger. Musculoskel Surg. 2013;97 Suppl 1:23–9. doi:10.1007/s12306-013-0261-4.

    Article  Google Scholar 

  6. Raiss P, Aldinger PR, Kasten P, Rickert M, Loew M. Total shoulder replacement in young and middle-aged patients with glenohumeral osteoarthritis. J Bone Joint Surg Br. 2008;90:764–9. doi:10.1302/0301-620X.90B6.20387. National Joint Registries will provide significant data for future claims both positive and negative regarding shoulder arthroplasty survivorship.

  7. Foruria AM, Sperling JW, Ankem HK, Oh LS, Cofield RH. Total shoulder replacement for osteoarthritis in patients 80 years of age and older. J Bone Joint Surg Br. 2010;92:970–4. doi:10.1302/0301-620X.92B7.23671.

    Article  CAS  PubMed  Google Scholar 

  8. Henn III RF, Ghomrawi H, Rutledge JR, Mazumdar M, Mancuso CA, Marx RG. Preoperative patient expectations of total shoulder arthroplasty. J Bone Joint Surg Am. 2011;93:2110–5. doi:10.2106/JBJS.J.01114.

    Article  PubMed  Google Scholar 

  9. Schrumpf M, Maak T, Hammoud S, Craig EV. The glenoid in total shoulder arthroplasty. Curr Rev Musculoskel Med. 2011;4:191–9. doi:10.1007/s12178-011-9096-5.

    Article  Google Scholar 

  10. Young AA, Walch G, Pape G, Gohlke F, Favard L. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than 5 years of follow-up. J Bone Joint Surg Am. 2012;94:685–93. doi:10.2106/JBJS.J.00727. National Joint Registries will provide significant data for future claims both positive and negative regarding shoulder arthroplasty survivorship.

  11. Dines D. Late-onset rotator cuff dysfunction after total shoulder arthroplasty—the "forgotten" complication. Commentary on an article by Allan A. Young, MD, et al. "Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than 5 years of follow-up". J Bone Joint Surg Am. 2012;94:e53. doi:10.2106/jbjs.k.00486.

  12. Ladermann A, Lubbeke A, Melis B, Stern R, Christofilopoulos P, Bacle G, et al. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am. 2011;93:1288–93. doi:10.2106/JBJS.J.00369.

    Article  CAS  PubMed  Google Scholar 

  13. Churchill RS. Trends in glenoid component design in unconstrained shoulder arthroplasty. JSES. 2011;20:s41-s6. doi:10.1016/j.jse.2010.10.036.

  14. Bell RH, Noble JS. The management of significant glenoid deficiency in total shoulder arthroplasty. J Shoulder Elbow Surg. 2000;9:248–56.

    Article  CAS  PubMed  Google Scholar 

  15. Abboud Ja Fau-Anakwenze OA. [J Am Acad Orthop Surg. 2012;21:23–31. doi:10.5435/JAAOS-21-01-23 2012 Abboud.pdf]. doi:10.5435/.

  16. http://depts.washington.edu/shoulder/ListShoulderProstheses.htm.Accessed 9 Sept 2013.

  17. Hardaker RN. Pyrocarbon joint resurfacing of the shoulder: is it clinically safe and effective? At http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_communications/documents/reports_results/wpc118144.pdf. Accessed Sept. 9 2013.

  18. Mansat P, Coutié A-S, Bonnevialle N, Rongières M, Mansat M, Bonnevialle P. Resurfacing humeral prosthesis: do we really reconstruct the anatomy? J Shoulder Elbow Surg. 2013;22:612–619. doi:10.1016/j.jse 2012.07.014. National Joint Registries will provide significant data for future claims both positive and negative regarding shoulder arthroplasty survivorship.

  19. Churchill RS. Trends in glenoid component design in unconstrained shoulder arthroplasty. J Shoulder Elbow Surg. 2011;20(2):S41–6. doi:10.1016/j.jse.2010.10.036.

    Article  PubMed  Google Scholar 

  20. Gerber C, Costouros JG, Sukthankar A, Fucentese SF. Static posterior humeral head subluxation and total shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18:505–10. doi:10.1016/j.jse.2009.03.003.

    Article  PubMed  Google Scholar 

  21. Spencer Jr EE, Valdevit A, Kambic H, Brems JJ, Iannotti JP. The effect of humeral component anteversion on shoulder stability with glenoid component retroversion. J Bone Joint Surg Am. 2005;87:808–14. doi:10.2106/JBJS.C.00770.

    Article  PubMed  Google Scholar 

  22. Sears BW, Johnston PS, Ramsey ML, Williams GR. Glenoid bone loss in primary total shoulder arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2012;20:604–13. doi:10.5435/JAAOS-20-09-604.

    Article  PubMed  Google Scholar 

  23. Gregory T, Hansen U, Emery R, Amis AA, Mutchler C, Taillieu F, et al. Total shoulder arthroplasty does not correct the orientation of the eroded glenoid. Acta Orthop. 2012;83:529–35.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Green A, Norris TR. Shoulder arthroplasty for advanced glenohumeral arthritis after anterior instability repair. J Shoulder Elbow Surg. 2001;10:539–45. doi:10.1067/mse.2001.118007.

    Article  CAS  PubMed  Google Scholar 

  25. Denard PJ, Walch G. Current concepts in the surgical management of primary glenohumeral arthritis with a biconcave glenoid. J Shoulder Elbow Surg. 2013;22:1589–98.

    Article  PubMed  Google Scholar 

  26. Mizuno N, Denard PJ, Raiss P, Walch G. Reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis in patients with a biconcave glenoid. J Bone Joint Surg Am. 2013;95:1297–304. doi:10.2106/JBJS.L.00820. The notion that reverse shoulder arthroplasty results are better than orthodox shoulder arthroplasties for B2 glenoids is both controversial and arguable on many grounds

    Google Scholar 

  27. Gilmer BB, Comstock BA, Jette JL, Warme WJ, Jackins SE, Matsen FA. The prognosis for improvement in comfort and function after the ream-and-run arthroplasty for glenohumeral arthritis: an analysis of 176 consecutive cases. J Bone Joint Surg. 2012;94:e102:1–9.

    Google Scholar 

  28. Trouilloud P, Gonzalvez M, Martz P, Charles H, Handelberg F, Nyffeler R, et al. Duocentric reversed shoulder prosthesis and personal fit templates: innovative strategies to optimize prosthesis positioning and prevent scapular notching. Eur J Orthopaed Surg Traumatol. 2013:1–13.

  29. Iannotti JP, Ricchetti ET, Rodriguez EJ, Bryan JA. Development and validation of a new method of 3-dimensional assessment of glenoid and humeral component position after total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22:1413–22. doi:10.1016/j.jse2013.01.005

    Google Scholar 

  30. Ekelund A, editor. New Trends in Shoulder Arthroplasty. European Instructional Lectures: Volume 13, 2013, 14th EFORT Congress, Istanbul, Turkey; Springer; 2013.

  31. Sabesan V, Callanan M, Ho J, Iannotti JP. Clinical and radiographic outcomes of total shoulder arthroplasty with bone graft for osteoarthritis with severe glenoid bone loss. J Bone Joint Surg Am. 2013;95:1290–6. doi:10.2106/JBJS.L.00097.

    Article  PubMed  Google Scholar 

  32. Iannotti JP, Lappin KE, Klotz CL, Reber EW, Swope SW. Liftoff resistance of augmented glenoid components during cyclic fatigue loading in the posterior-superior direction. J Shoulder Elbow Surg. 2013. doi:10.1016/j.jse.2013.01.018. National Joint Registries will provide significant data for future claims both positive and negative regarding shoulder arthroplasty survivorship.

  33. Hermida JC, Flores-Hernandez C, Hoenecke HR, D'Lima DD. Augmented wedge-shaped glenoid component for the correction of glenoid retroversion: a finite element analysis. J Shoulder Elbow Surg. 2013. doi:10.1016/j.jse.2013.06.008.

  34. Lafosse L, Schnaser E, Haag M, Gobezie R. Primary total shoulder arthroplasty performed entirely thru the rotator interval: technique and minimum two-year outcomes. J Shoulder Elbow Surg. 2009;18:864–73. doi:10.1016/j.jse.2009.03.017.

    Article  PubMed  Google Scholar 

  35. Terrier A, Larrea X, Malfroy Camine V, Pioletti D, Farron A. Importance of the subscapularis muscle after total shoulder arthroplasty. Clin Biomech. 2013;28:146–50. doi:10.1016/j.clinbiomech2012.11.010.

    Google Scholar 

  36. Ives EP, Nazarian LN, Parker L, Garrigues GE, Williams GR. Subscapularis tendon tears: a common sonographic finding in symptomatic postarthroplasty shoulders. J Clin Ultrasound. 2013;41:129–33. doi:10.1002/jcu.21980

    Google Scholar 

  37. Sperling JW, editor. Subscapularis Tenotomy: Optimal Approach to Shoulder Replacement: Affirms. Seminars in Arthroplasty; Elsevier; 2012.

  38. Van den Berghe GR, Nguyen B, Patil S, D'Lima DD, Mahar A, Pedowitz R, et al. A biomechanical evaluation of three surgical techniques for subscapularis repair. J Shoulder Elbow Surg. 2008;17:156–61. doi:10.1016/j.jse.2007.04.016.

    Article  PubMed  Google Scholar 

  39. Miller BS, Joseph TA, Noonan TJ, Horan MP, Hawkins RJ. Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome. J Shoulder Elbow Surg. 2005;14:492–6. doi:10.1016/j.jse.2005.02.013.

    Article  PubMed  Google Scholar 

  40. Blalock R, Galatz LM, editors. Rotator Cuff Tears After Arthroplasty. Seminars in Arthroplasty; Elsevier; 2012.

  41. Talbot JC, Watts AC, Grimberg J, Funk L. Shoulder tendon transfers for rotator cuff deficiency. Shoulder Elbow. 2013;5:1–11.

    Article  Google Scholar 

  42. Nicholson GP, Twigg S, Blatz B, Sturonas-Brown B and Wilson J. Subscapularis Lengthening in Shoulder Arthroplasty. J Shoulder Elbow Surg. 2010;19:427–33. doi:10.1016/j.jse.2009.05.017.

  43. Van Thiel GS, Wang VM, Wang FC, Nho SJ, Piasecki DP, Bach Jr BR, et al. Biomechanical similarities among subscapularis repairs after shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19:657–63. doi:10.1016/j.jse.2010.01.014.

    Article  PubMed  Google Scholar 

  44. Edwards TB. Shoulder replacement surgery. Orthopedics. 2012;35:865–6.

    Article  PubMed  Google Scholar 

  45. Firestone D, Arnold RM, Fehringer EV. Two‐year follow‐up of shoulder hemiarthroplasty with a CTA head for cuff‐tear arthropathy. Shoulder Elbow. 2012;4:174–8.

    Article  Google Scholar 

  46. Moen TC, Hsu SH, Bigliani LU, editors. Intraoperative Issues Dictated by Diagnosis: Cuff Deficiency: Allograft, Transfer, or Advance. Seminars in Arthroplasty; Elsevier; 2012;23:68–73.

  47. Lo EY, Moen TC, Burkhead WZ, editors. Instability failure in total shoulder arthroplasty. Seminars in Arthroplasty; Elsevier; 2013;24:28–32.

    Google Scholar 

  48. Namdari S, Voleti P, Baldwin K, Glaser D, Huffman GR. Latissimus Dorsi tendon transfer for irreparable rotator cuff tears: a systematic review. J Bone Joint Surg. 2012;94:891–8.

    Article  PubMed  Google Scholar 

  49. Puskas GJ, Catanzaro S, Gerber C. Clinical outcome of reverse total shoulder arthroplasty combined with latissimus dorsi transfer for the treatment of chronic combined pseudoparesis of elevation and external rotation of the shoulder. J Shoulder Elbow Surg. 2014;23:49–57. National Joint Registries will provide significant data for future claims both positive and negative regarding shoulder arthroplasty survivorship.

  50. Redfern T, Wallace W, Beddow F. Clavicular osteotomy in shoulder arthroplasty. Int Orthopaed. 1989;13:61–3.

    Article  CAS  Google Scholar 

  51. Hoppenfeld S, Buckley R. Surgical exposures in orthopaedics: the anatomic approach. Philadelphia, USA; Lippincott Williams & Wilkins; 2012.

  52. Lapner PL, Sabri E, Rakhra K, Bell K, Athwal GS. Comparison of lesser tuberosity osteotomy to subscapularis peel in shoulder arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94:2239–46. doi:10.2106/JBJS.K.01365.

    Article  PubMed  Google Scholar 

  53. Fama G, Nava P, Pini S, Cossettini MM, Pozzuoli A. Management of the subscapularis contracture during shoulder arthroplasty for primary glenohumeral arthritis. La Chirurgia Degli Organi Di Movimento. 2008;91:71–7. doi:10.1007/s12306-007-0012-5.

    Article  PubMed  Google Scholar 

  54. De Wilde LF, De Coninck T, De Neve F, Berghs BM. Subscapularis release in shoulder replacement determines structural muscular changes. Clin Orthopaed Rel Res. 2012;470:2193–201. doi:10.1007/s11999-012-2291-x.

    Article  Google Scholar 

  55. Hernigou P, Duparc F, Hernigou A. Determining humeral retroversion with computed tomography. J Bone Joint Surg Am. 2002;84A:1753–62.

    Google Scholar 

  56. Boileau P, Walch G. The surgical anatomy and osteotomy technique for the humeral head. Shoulder Arthroplasty. New York, USA;Springer; 1999. pp. 105–23.

  57. Boileau P, Bicknell R, Mazzoleni N, Walch G, Urien J. CT scan method accurately assesses humeral head retroversion. Clin Orthopaed Rel Res. 2008;466:661–9.

    Article  CAS  Google Scholar 

  58. Sassoon A, Schoch B, Rhee P, Schleck C, Harmsen W, Sperling J, et al. The role of eccentric and offset humeral head variations in total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22:886–93

    Google Scholar 

  59. Maccioni CB, Sonnabend D. Metal‐backed glenoid prostheses. Shoulder & Elbow. 2013;5:217–220

  60. Budge MD, Nolan EM, Heisey MH, Baker K, Wiater JM. Results of total shoulder arthroplasty with a monoblock porous tantalum glenoid component: a prospective minimum 2-year follow-up study. J Shoulder Elbow Surg. 2013;22:535–41.

    Google Scholar 

  61. Levine WN, Fischer CR, Nguyen D, Flatow EL, Ahmad CS, Bigliani LU. Long-term follow-up of shoulder hemiarthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am. 2012;94:e164. doi:10.2106/JBJS.K.00603.

    Article  PubMed  Google Scholar 

  62. Namba RS, Thornhill TS. Posterior capsulorrhaphy in total shoulder arthroplasty. A case report. Clin Orthopaed Rel Res. 1995:135–9.

  63. Fusaro I, Orsini S, Stignani S, Creta D, Cava F, Benedetti M. Proposal for SICSeG guidelines for rehabilitation after anatomical shoulder prosthesis in concentric shoulder osteoarthritis. Musculoskel Surg. 2013;97:31–7. doi:10.1007/s12306-013-0257-0

    Google Scholar 

  64. Groh GI, Groh GM. Complications rates, reoperation rates, and the learning curve in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2013. doi:10.1016/j.jse.2013.06.002

  65. Jackson JD, Cil A, Smith J, Steinmann SP. Integrity and function of the subscapularis after total shoulder arthroplasty. J Shoulder Elbow Surg. American Shoulder and Elbow Surgeons, et al. 2010;19:1085–90. doi:10.1016/j.jse.2010.04.001.

  66. Miller SL, Hazrati Y, Klepps S, Chiang A, Flatow EL. Loss of subscapularis function after total shoulder replacement: a seldom recognized problem. J Shoulder Elbow Surg. 2003;12:29–34.

    Article  PubMed  Google Scholar 

  67. Abdel M, Hattrup S, Sperling J, Cofield R, Kreofsky C, Sanchez-Sotelo J. Revision of an unstable hemiarthroplasty or anatomical total shoulder replacement using a reverse design prosthesis. Bone Joint J. 2013;95:668–72.

    Article  PubMed  Google Scholar 

  68. Hasan SS, Leith JM, Campbell B, Kapil R, Smith KL, Matsen III FA. Characteristics of unsatisfactory shoulder arthroplasties. J Shoulder Elbow Surg. 2002;11:431–41.

    Article  PubMed  Google Scholar 

  69. Katthagen JC, Jensen G, Voigt C, Lill H. [Shoulder stiffness]. Der Unfallchirurg. 2012;115:527–38; quiz 39-40. doi:10.1007/s00113-012-2234-8. National Joint Registries will provide significant data for future claims both positive and negative regarding shoulder arthroplasty survivorship.

  70. Pottinger P, Butler-Wu S, Neradilek MB, Merritt A, Bertelsen A, Jette JL, et al. Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening. J Bone Joint Surg Am. 2012;94:2075–83. doi:10.2106/JBJS.K.00861. National Joint Registries will provide significant data for future claims both positive and negative regarding shoulder arthroplasty survivorship.

  71. Shannon SK, Mandrekar J, Gustafson DR, Rucinski SL, Dailey AL, Segner RE, et al. Anaerobic thioglycolate broth culture for recovery of Propionibacterium acnes from shoulder tissue and fluid specimens. J Clin Microbiol. 2013;51:731–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Maike Mueller declares no conflicts of interest. Gregory Hoy receives travel/accommodation expenses from, and is a paid consultant for Depuy Synthes and Integra; he also receives payment for development of educational presentations from Depuy Synthes.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

Author information

Authors and Affiliations

  1. Evangelisches Waldkrankenhaus, Spandau, Berlin, Germany

    Maike Mueller

  2. Melbourne Orthopaedic Group, 33 The Avenue, Windsor, 3181, Victoria, Australia

    Gregory Hoy

Authors
  1. Maike Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory Hoy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory Hoy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mueller, M., Hoy, G. Soft tissue balancing in total shoulder replacement. Curr Rev Musculoskelet Med 7, 16–21 (2014). https://doi.org/10.1007/s12178-013-9195-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-013-9195-6

Keywords

Search

Navigation