Original article
Shoulder arthroplasty: The socket perspective

https://doi.org/10.1016/j.jse.2007.02.112Get rights and content

Although much attention has been directed to the development of the humeral components used in shoulder arthroplasty, the major unsolved challenge lies on the glenoid side of the articulation. This challenge arises from difficulties resisting eccentric loading and providing adequate implant-bone fixation. Current glenoid component designs use polyethylene and polymethyl methacrylate and are prone to loosening, plastic deformation, particulate debris, and third-body wear. Metal-backed components present further challenges, and results have generally been disappointing. There is interest in biologic resurfacing procedures, including the interposition of fascia, capsule, or meniscal allograft and nonprosthetic glenoid arthroplasty, or what has become known as the “ream-and-run” procedure. Despite encouraging results, important questions remain unanswered about these procedures. However, each may warrant further exploration with a goal of providing an effective and durable approach to glenoid arthritis that avoids the risks associated with polymethyl methacrylate and polyethylene.

Section snippets

Complications of total shoulder arthroplasty

Although the details of the pathogenesis and progression of glenoid arthritis have yet to be defined precisely, it is apparent that compromise of the structure or mechanical properties of the labrum and cartilage of the glenoid, the “soft side” of the articulation, will result in loss of the normal load-distributing and stabilizing mechanisms of the joint. With loss of the even distribution of the humeral force, local concentrations of load accelerate the deformation and deterioration of the

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