Shoulder replacement: Emerging trends

PURPOSE OF REVIEW: Total shoulder arthroplasty is a highly effective and predictable treatment for degenerative conditions of the glenohumeral joint. Improving implant survival by limiting complications, such as component loosening, has been the focus of a great deal of recent research. RECENT FINDINGS: Despite advances in component design and fixation, glenoid loosening remains a common indication for revision. Modern cement techniques, convex backing and pegged designs have been shown to improve radiographic results for cemented polyethylene components. Despite the theoretical advantage of permanent biologic fixation, metal-backed glenoid components have not had recent clinical success, and continued research in this area is necessary. Materials such as porous tanatalum may offer improved ingrowth fixation and increased component longevity. Humeral surface replacement is an alternative to traditional stemmed shoulder arthroplasty, and clinical studies are promising. Regional anesthesia is being used safely and effectively in shoulder surgery, and may allow shoulder arthroplasty to be performed on an outpatient basis. SUMMARY: The overall complication rate of total shoulder arthroplasty may be decreasing, but issues such as glenoid loosening remain problematic. Advances will aim to improve patient function and implant longevity. This review discusses current trends and areas of recent research in the field of shoulder replacement.