Last Updated: December 13, 2013
Glenohumeral arthroplasty provides the surgeon with the opportunity to use all the principles related to the restoration of motion strength stability and smoothness. All adhesions and contractures must be released and the smoothness of the nonarticular humeroscapular motion interface must be reestablished. Obligate translation is avoided by appropriate capsular releases. Strength is optimized by placing the muscle-tendon units under proper tension. Stability is achieved by normalizing joint surface orientation and providing the appropriate geometry for the concavity compression stabilization and balance mechanisms. Smoothness is provided by the prosthetic joint surfaces and by immediate postoperative motion.
Preparation of the patient
While a general anesthetic can be used a brachial plexus block has the advantage of providing about 12 hours of anesthesia in the surgical area. The patient is placed in the beach chair position with the thorax up at an angle of 30 degrees. The shoulder is just off the edge of the operating table so it can be moved freely through an entire range of motion. The anesthesiologist is positioned at the side of the neck on the opposite side from the shoulder being operated. A gowned member of the surgical team performs a careful skin preparation including the entire arm and forequarter anteriorly and posteriorly. This preparation is repeated after a change of gown and gloves. The coracoid process (the lighthouse of the shoulder) is located. The deltopectoral groove extending across it is identified by palpation and marked as the line of incision.
Draping allows access to the entire scapula clavicle and humerus.