Shoulder Arthrodesis in the Management of Glenohumeral Pathologies

Abstract

Background In an era of advanced shoulder stabilization procedures, arthroplasty implants and techniques, shoulder arthrodesis is considered an end-stage salvage procedure with negative connotations. However, in correctly selected patients, arthrodesis can alleviate pain, provide acceptable and stable motion, with a resultant functional shoulder. Methods The current literature on shoulder arthrodesis was reviewed to determine the indications, surgical technique, post-operative rehabilitation, complications and outcomes. Results Indications for shoulder arthrodesis include brachial plexus injuries, paralytic disorders, pseudo paralysis from combined severe/irreparable rotator cuff and deltoid injuries, inflammatory arthritis with severe rotator cuff pathology, persistent refractory instability, and tumor resection. Shoulder arthrodesis generally involves compression screws with or without plate fixation and bone graft. The arthrodesis is positioned to optimize the function of the extremity, primarily for activities of daily living. Postoperatively, most patients are immobilized for 8 to 10 weeks, dependent on the completeness of radiological fusion. Complications include nonunion, shoulder girdle muscle atrophy, painful hardware, periprosthetic fractures, and infection. Discussion With the use of recent biological innovations, the nonunion rate has declined, and rehabilitation technologies have allowed maintenance of muscle mass for future conversion to shoulder arthroplasty. Hence, in carefully selected patients, shoulder arthrodesis provides a valuable option for a stable, functional, and pain-free shoulder and should be retained as part of the treatment algorithm for complex shoulder pathology.