loosening

Complications

Subscapularis failure

Rotator cuff failure

Instability

Infection

Periprosthetic fracture

Aseptic loosening

Neurological injury

Parada et al. J Should Elbow Surg 2021

- 2224 aTSA complication rate 11%, revision rate 5.6%

History

First generation (late 70s early 80s) 

Results

1.  Infection

Peters et al J Arthroplasty 2009

Intraoperative glenoid fracture

Avoid by

- careful reaming and drilling osteoporotic bone

Management

1.  Rotate metaglene

- use locking screws to stabilise glenoid

2.  PA screws

- cannulated 4.0 mm screws

- inserted percutaneously from posterior

Haematomas

Great deal of dead space is created

- always use a drain

Goal

Initial press fit

- implant geometry fits the cortical bone in the proximal femur

- good initial mechanical stability

Biological fixation for success

- good press fit

- minimal micromotion

- bony or fibrous tissue ingrowth or ongrowth

Concept

Femur

- removal of femoral head cartilage

- resurfacing with metal

- cemented / uncemented

Acetabulum

- standard technique

Bearing surface

- metal on metal

Indications

Relatively young man (40 - 50)

OA