In 2006 the American surgeon has more FDA-approved options for the treatment of shoulder arthritis than ever before. Individualization of patient care, matching the patients’ needs with an implant that can reliably meet those needs is now a reality. While the short-term goals will, in most cases, be reliably met, it is also important to match the implant or surgical technique to the patient’s age, both chronologic and physiologic, activity level, and general health profile. Making these determinations, with the exception of those with life-threatening comorbidities, still falls within the art of medicine at this time. The indications results and long-term benefits will need to be quantified and scientifically studied to determine which patients will most likely benefit in an enduring fashion from application of this expensive technology as the cost of these new technologies and their application greatly outreaches the payers’ reimbursement to the hospital. Therefore, at some point the system will no longer be able to afford these implants at their current costs and some rationing will inevitably be required.
The following four articles will provide the reader with an updated view of each of these devices and their recent modifications and track record. The reader should not apply any of these technologies without a great deal of soul searching as regards ones’ expertise nor without independent or organized study of the anatomy, surgical approaches, biomechanics, and potential complication recognition and management associated with shoulder arthroplasty.
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