Shoulder Arthritis: Total Shoulder Replacement Humerus (ball) Preparation

Shoulder Arthritis: Total Shoulder Replacement Humerus (ball) Preparation

The following video is a surgical demonstration of an anatomic shoulder replacement on a right shoulder. This demonstration will show the preparation of a stemless shoulder implant to replace the ball of the shoulder, known as the humeral head.

Here, the right shoulder has been prepared for surgery using a sterile technique to help reduce the risk of infection. The surgeon has marked out the incision used to gain access to the shoulder joint. The most common approach to a shoulder replacement is called the deltopectoral approach. Here, the surgeon will dissect between the deltoid and pectoralis major muscles to access the shoulder joint.

Once the joint is exposed, the ball will be dislocated from the socket, the glenoid. Next, the surgeon will prepare to remove the arthritic ball by marking out where they want to make the saw cuts. While cutting, great care is taken to preserve the supraspinatus and infraspinatus tendons, which are part of the rotator cuff and are needed in order for the shoulder to function after surgery.

Once the arthritic head is removed, the surgeon will size the metal plate implant, called the trunnion, using a guide. This guide will remain in place and help the surgeon perform a series of steps to prepare the bone for the screw, which will provide additional fixation of the trunnion to bone and will be used later in the case.

After the upper arm bone is prepared, a protective cap is placed on the cut surface. Next, the surgeon will move on to replace the socket with an artificial socket of their choice. Once the socket implant is in place, the surgeon goes back to the upper arm and removes the protective cap.

Now, the surgeon will put in the final implants. This includes impacting the trunnion into place and securing it with the screw. Finally, the metal ball is impacted into place on top of the trunnion and screw. Once the implants are in, the surgeon will reduce the ball of the upper arm back into the socket and check the shoulder for stability by taking it through different motions.

For closure of the surgical site. The surgeon will reapproximate the front tendon of the rotator cuff, the subscapularis, back into position, followed by soft tissue and skin.