Indications
Indications have narrowed
- due to success of shoulder arthroplasty
1. Chronic infections of GHJ
2. Stabilization in paralytic disorders
3. Post-traumatic brachial plexus palsy
4. Salvage of failed GHJ Arthroplasty
- may need bone graft procedures
5. Arthritic diseases unsuitable for arthroplasty / young patient
6. Stabilization after resection for neoplastic lesions
Contra-Indications
Ipsilateral elbow fusion
Contralateral shoulder arthrodesis
Paralysis of scapula-stabilisers (no movement possible)
Charcot arthropathy (low chance union)
Advantages
Permanent solution
Disadvantages
Loss of movement at shoulder
Difficulty with activities at head level or behind the back
Perineal care
Feeding
Loss of movement at other joints 2° prolonged immobilisation
Results
80-95% patient satisfaction
Union rates ~ 95%
Aims
Rowe 1974 Requisites after Shoulder Arthrodesis
1. Hand should reach face / head / mid-line of the body anteriorly & posteriorly
- thumb to chin
- reach axilla, mouth and belt buckle
- combination of forward flexion and elbow flexion
2. Shoulder be comfortable at rest / scapula should not be prominent
- arm should hang by side with scapula flat against thorax
- no winging
Position
Rockwood et al JBJS Am April 2001
- Abduction 10-15°
- Flexion 10-15°
- Internal Rotation 45°
Issues
1. Technically difficult to obtain correct position intra-operatively
2. IR most important to later function
3. Position in reference to trunk not scapula
4. Avoid excessive abduction & flexion
- forces the scapula to rotate & wing at rest
- leads to fatigue & discomfort
Principles
1. Need painless, supple joints above & below
2. Rigidly stabilise congruent vascular cancellous surfaces under compression
3. Bone graft & splint as needed
Options
Intra-articular / glenohumeral
Extra-articular / acromio-humeral
Combined
Principles
Approach
A. Posterior
- detach deltoid from spine
- between IS and TM
B. Anterior
- detach deltoid from clavicle
Technique
- denude GHJ cartilage
- denude superior humeral head and undersurface acromion
- arthrodesis between humeral head and glenoid / acromion
- temporarily fix with steinman pins GHJ and acromion-humerus
- check position / ROM / no winging
- if satisfactory, insert GHJ and acromial-humeral compression screws
- humerus - acromial plate if anterior approach
- humerus - scapular spine plate if posterior approach
Complications
Early skin breakdown
Loss elbow flexion
Non-union
Mal-union
Painful metalwork
Breakage of metalwork
Suprascapular nerve entrapment
AC joint OA
Results
Cofield & Briggs JBJS 1979
- 71 fused shoulders
- average 9 year follow up
- 96% union rate
- 75% adequate pain relief
- 70% good functional result