Treatment of Glenohumeral Arthritis with a Hemiarthroplasty by Michael A. Wirth, R. Stacy Tapscott, Carleton Southworth, and Charles A. Rockwood J Bone.

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Arthroscopic Glenohumeral Arthrodesis With O-Arm Navigation

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Treatment of Glenohumeral Arthritis with a Hemiarthroplasty by Michael A. Wirth, R. Stacy Tapscott, Carleton Southworth, and Charles A. Rockwood J Bone Joint Surg Am Volume 89(2 suppl 1):10-25 March 1, 2007 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The patient is positioned at the edge of the operating table in a beach-chair position with the head supported on a McConnell headrest (McConnell Orthopaedic Manufacturing, Greenville, Texas). Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The subscapularis is incised at its insertion to the lesser tuberosity (arrows) and is tagged with several 1-mm Cottony Dacron sutures (Deknatel, Fall River, Massachusetts). Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Medial reattachment of the subscapularis tendon functionally lengthens the muscle-tendon unit by 1 to 2 cm, resulting in an improved range of motion. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The varus-valgus angle of humeral head resection is determined with an osteotomy template positioned in line with the long axis of the humeral shaft. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The lateral aspect of the subscapularis fossa at a point midway between the superior and lateral borders of the scapula is described as the “centering point.”. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Osteophytes are removed to increase exposure and to prevent motion-limiting abutment. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Ideally, drawer testing demonstrates 40% to 60% posterior translation of the humeral head relative to the center of the glenoid. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Achieving 75° to 90° of internal rotation is the goal when assessing soft-tissue balance with the arm positioned in 90° of abduction. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The hand is placed on the contralateral shoulder while the operatively treated shoulder is observed for protraction of the scapula. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Preoperative templating in this case should alert the surgeon to the possibility of suboptimal placement of the prosthetic head and “joint stuffing.”. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Computed tomography scan demonstrating approximately 30° of posterior glenoid erosion relative to the plane of the scapular body. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Carefully placed retractors help to identify the rotator cuff insertion and to protect the cuff integrity during humeral head resection. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Glenohumeral stability is suboptimal when the glenoid center line is not collinear with the net humeral joint reaction force. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Radiograph of a patient with persistent pain and stiffness following hemiarthroplasty. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Overstuffing of the shoulder joint secondary to an overly large humeral head component usually results in pain, shoulder stiffness, and compromise of the rotator cuff. Michael A. Wirth et al. J Bone Joint Surg Am 2007;89:10-25 ©2007 by The Journal of Bone and Joint Surgery, Inc.