What's New in Shoulder Surgery
Gary M. Gartsman, MD; Samer S. Hasan, MD, PhD

The purpose of this update on shoulder surgery is to discuss, in summary fashion, topics presented at selected orthopaedic meetings during the time-period of August 1999 to July 2000. Sources for this article were presentations and symposia at meetings of the American Orthopaedic Society for Sports Medicine (Specialty Day, Orlando, Florida, March 2000, and the Twenty-sixth Annual Meeting, Sun Valley, Idaho, June 2000), the Arthroscopy Association of North America (Specialty Day, Orlando, Florida, March 2000, and the Nineteenth Annual Meeting, Miami, Florida, April 2000), the American Academy of Orthopaedic Surgeons (Sixty-seventh Annual Meeting, Orlando, Florida, March 2000), the American Shoulder and Elbow Surgeons (Specialty Day, Orlando, Florida, March 2000, and the Sixteenth Annual Meeting, Philadelphia, Pennsylvania, October 1999), and the American Orthopaedic Association (113th Annual Meeting, Hot Springs, Virginia, June 2000).

Arthroplasty

Developments in the Design of Prosthetic Shoulder Arthroplasty

Humerus

Recent developments in the design of humeral head replacements have focused on enhancing the ability of the prosthesis to replicate normal anatomic relationships. These third-generation modular designs provide both variable neck-shaft angles and multiple head offsets in three dimensions. M.L. Pearl performed a three-dimensional analysis in cadavers and demonstrated that the variable geometry of the third-generation prosthetic system allowed for significantly better replication of the three-dimensional position of the center of rotation and the articulation point with preservation of the articular surface arc compared with the second-generation prosthetic systems. The most troublesome feature of the second-generation modular systems was the gap that was created by the prosthetic collar and the Morse taper between the prosthetic head and the humeral osteotomy site. Some newer designs have eliminated this gap. J.J.P. Warner compared hemiarthroplasty with use of a second-generation design with hemiarthroplasty with use of a third-generation design. The head-to-tuberosity height was greater than that on the contralateral, normal side in patients who underwent hemiarthroplasty with a second-generation prosthesis. Moreover, these …


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