Arthritis of Dislocation: Recapturing Rotation

Most current surgical procedures that are performed for the treatment of recurrent anterior shoulder instability recognize the importance of preserving external rotation. However, many of the more classic procedures such as the Putti-Platt, Magnusson, and Bristow Latarjet resulted in significant permanent loss of this critical motion. It is now understood that surgically induced loss of external rotation, as a result of instability repairs, is a significant prognostic factor in the development of arthritis of dislocation. A very important consideration during shoulder replacement surgery in the treatment of arthritis of dislocation is to reestablish functional external rotation of the new joint. Surgical techniques including subscapularis lengthening, subscapularis advancement, and capsular management must become part of the armamentarium of the shoulder surgeon who deals with this complex problem. This presentation will review the pathology and treatment considerations in dealing with loss of external rotation during shoulder replacement surgery.