Shoulder Arthroplasty Implants - Origins and Developmennt
Mr Steve Bale FRCS(Orth)
Fellows Teaching 26/9/14
Jules Pean 1893
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
“.... a virtuoso of the knife, who amputates three legs and two arms in quick succession, dismantles a couple of shoulders, trepans five crania, takes out half a dozen wombs and cuts off a few testicles. He works like this for about two hours. He is dripping with blood and sweat. His feet stand in pools of blood.” Léon Daudet
Charles Neer
Fellows Teaching 26/9/14
Charles Neer
• Neer CS Am J Surg 1955;901-7
• Neer CS J Bone Joint Surg 1970;1090-1103
• Neer CS J Bone Joint Surg 1974;1-13
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
Hemiarthroplasty
Total Shoulder Replacement
Neer Prostheses
Fellows Teaching 26/9/14
• Monobloc prostheses
• Limited stem options
• Fixed neck angle
• No offset
Fellows Teaching 26/9/14
Shoulder Arthroplasty
Fellows Teaching 26/9/14
Good cuff
No cuff
Charles Neer
Fellows Teaching 26/9/14
“In the future…the basic design of the articular surfaces should remain the same as normal anatomy. No biomechanical theory can improve on anatomical design.”
Fellows Teaching 26/9/14
Cuff deficient shoulders
Reverse Designs
Semi-constrained
Big Heads
Bipolar
Fellows Teaching 26/9/14
Bi-polar Arthroplasty
Fellows Teaching 26/9/14
Big Head
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
JBJS 1982; 47-51
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
Paul Grammont
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
Fellows Teaching 26/9/14
Biomechanics
• Large glenosphere with no neck
• Small humeral cup covering less than half of the glenosphere