Shoulder arthroplasty in 2002

Since Péan in 1893 and Judet in 1947, shoulder arthroplasty subsequentlyevolved with the original concept of non constrained prothesisproposed by Neer in 1951. All actual modular and adaptableshoulder arthroplasties are based on this concept, which associatesboth repair of soft tissues and postoperative comprehensive rehabilitationprogram. Preoperative imaging give information on the statusof rotator cuff and the glenoid bone stock and allows preoperativechoice between humeral or total shoulder arthroplasty. Shoulderarthroplasty needs a good management of soft tissues and ameticulous surgical technique, particularly in the treatment of acutecomplex fractures in elderly patients. Best functional results areobtained in primary osteoarthritis and avascular necrosis of humeralhead. In rheumatoid arthritis, pain is lessened and function is improved.Results in post traumatic and post instability osteoarthritisdepend on preoperative status of soft tissues. Choice of type ofprosthesis is actually very controversial in cuff tear arthroplasy.Complications of shoulder arthroplasty depend on non selectiveindications, operative technique and aetiology.In 2002, shoulder arthroplasty is a reliable long-term therapeuticalternative with a 90% survival after 10 years and 87 % survivalafter 15 years, when performed by an experienced team in the fieldof shoulder’s surgery and rehabilitation.