Summary The described procedure is an anatomic total shoulder replacement workflow using a humeral stemless anchor and referencing anatomic glenoid and anatomic hybrid glenoid options The technique emphasizes a subscapularis-sparing exposure followed by humeral resection, glenoid preparation, humeral preparation, trialing, and final implantation with dedicated INTACT instruments Indications Indications the INHANCE Shoulder System with the humeral stemless anchor is intended for use in anatomic total shoulder replacement procedures to address osteoarthritis post-traumatic arthrosis focal avascular necrosis of the humeral head previous surgeries of the shoulder that do not compromise the fixation Contraindications nonfunctional deltoid muscle inadequate bone stock active or suspected infection Anatomy Osteology humeral head greater tuberosity surgical neck of the humerus humeral shaft calcar bicipital groove glenoid face glenoid fossa glenoid neck glenoid vault coracoid Muscles subscapularis supraspinatus deltoid latissimus dorsi biceps Ligaments glenohumeral ligaments medial glenohumeral ligaments Nerves axillary nerve Blood supply circumflex vessels Approach The INHANCE Shoulder System is typically implanted using a deltopectoral approach, which provides direct access to the glenohumeral joint while preserving the deltoid In some cases, especially for reverse configurations, a superolateral (anterosuperior) approach may be used depending on surgeon preference and exposure needs Technical specifications The anatomic glenoid and anatomic hybrid glenoid are intended for cemented use only The resection guide approximates a 135° humeral resection angle when the Silhouette Resection Guide Pin is aligned with the humeral shaft anteriorly The resection version handle is set at 30° of retroversion and may be aligned with the forearm or manually set to an alternate version The Stepped Glenoid Drill has a stepped diameter of 3.2 mm distally to 4.0 mm proximally The Humeral Drill has a 4.0 mm drill diameter with a 3.2 mm trocar tip The Humeral Guide Pin is 4.0 x 130 The humeral sizers and humeral reamers are available in XS 28 S 32 M 36 L 40 XL 44 The glenoid reamers are available in XS S M L XL The anatomic glenoid trials are available in XS S M L XL The humeral head trial options are 38 x 13.5 40 x 13.75 40 x 15.75 42 x 14.5 42 x 16.5 44 x 15.25 44 x 17.25 46 x 16 46 x 18.5 48.5 x 17 48.5 x 19.5 51 x 18 51 x 20.5 54 x 19 54 x 22 57 x 20.5 57 x 24 Options INHANCE Reverse Shoulder System Peripheral Screws Design Image 15mm 20mm 25mm 30mm - 50mm Locking ✓ ✓ ✓ ✓ Locking & Self-Drilling (optional) X ✓ ✓ X Non-Locking (Optional) ✓ ✓ ✓ ✓ Central fixation Diameter 6.0mm 6.0mm 6.0mm 6.0mm 4.5mm 4.5mm Screw length 25mm 30mm 35mm 40mm 15mm 25mm Image R/SPEED baseplate Baseplate diameter 24mm 29mm Screw diameter 6.5mm 6.5mm Screw length 30mm 35mm Image