Introduction Replacement of humeral head and glenoid resurfacing cemented all-polyethylene glenoid resurfacing is standard of care Total shoulder arthroplasty unique from THA and TKA in that greater range of motion in the shoulder success depends on proper functioning of the soft tissues glenoid is less constrained leads to greater sheer stresses and is more susceptible to mechanical loosening Factors required for success of TSA rotator cuff intact and functional if rotator cuff is deficient and proximal migration of humerus is seen on x-rays (rotator cuff arthropathy) then glenoid resurfacing is contraindicated if there is an irreparable rotator cuff deficiency then proceed with hemiarthroplasty or a reverse ball prosthesis an isolated supraspinatus tear without retraction can proceed with TSA incidence of full thickness rotator cuff tears in patients getting a TSA is 5% to 10% if positive impingement signs on exam, order a pre-operative MRI glenoid bone stock and version if glenoid is eroded down to coracoid process then glenoid resurfacing is contraindicated see Walch classification below Outcomes pain relief most predictive benefit (more predictable than hemiarthroplasty) reliable range of motion good survival at 10 years (93%) good longevity with cemented and press-fit humeral components worse results for post-capsulorrhaphy arthropathy Classification Walch Classification of Glenoid Wear Type A Concentric wear, no subluxation of HH, well centered A1: no or minor central erosion A2: deeper central erosion, line connects anterior/posterior glenoid rims and transects humeral head (HH) Type B Biconcave glenoid, asymmetric glenoid wear and head subluxated posteriorly B0: pre-osteoarthritic posterior subluxation of HH B1: posterior joint narrowing (no posterior bone loss), osteophytes, subchondral sclerosis B2: posterior rim erosion, retroverted glenoid B3: mono-concave, posterior wear, at least HH subluxation >70% OR retroversion >15% Type C C1: Glenoid retroversion >25 degrees, regardless of erosion C2: Biconcave, posterior bone loss, posterior translation of HH Type D Glenoid anteversion or anterior HH subluxation (HH subluxation <40%) Indications Indications pain (anterior to posterior), especially at night, and inability to perform activities of daily living glenoid chondral wear to bone preferred over hemiarthroplasty for osteoarthritis and inflammatory arthritis posterior humeral head subluxation Contraindications insufficient glenoid bone stock rotator cuff arthropathy deltoid dysfunction irreparable rotator cuff (hemiarthroplasty or reverse total shoulder are preferable) risk of loosening of the glenoid prosthesis is high ("rocking horse" phenomenon) active infection brachial plexus palsy Preoperative Imaging Radiographs true AP determine extent of arthritis and look for superior migration of humerus axillary view look for posterior wear of glenoid CT scan obtain CT scan to determine glenoid version and glenoid bone stock MRI evaluate rotator cuff condition Approach Deltopectoral detach the subscapularis and capsule from anterior humerus dislocate shoulder anteriorly tight shoulders may require release of the upper half of the pectoralis tendon to increase exposure and dislocation pectoralis major tendon passes on top of the biceps tendon to attach to the humerus Complications axillary nerve damage is the most common complication axillary nerve and posterior humeral circumflex artery pass beneath the glenohumeral joint in the quadrilateral space Technical considerations Capsule anterior capsule contracture (passive ER < 40°) treatment anterior release and Z-lengthening posterior capsule stretching treatment volume-reducing procedure (plication of posterior capsule) Subscapularis no differences in outcomes between subscapularis peel, lesser tuberosity osteotomy, subscapularis tenotomy, partial tenotomy Glenoid deficiency and retroversion glenoid deficiency treatment build up with iliac crest autograft or part of the resected humerus do not use cement to build up the deficiency retroverted glenoid treatment build up posterior glenoid with allograft eccentrically ream anterior glenoid Glenoid component convex backside superior to flat recreate neutral version peg design is biomechanically superior to keel design polyethylene-backed components superior to metal-backed components glenoid not large enough to accommodate both metal and PE uncemented glenoid has a lower rate of loosening conforming vs. nonconforming both have advantages and neither is superior conforming is more stable but leads to rim stress and radiolucencies nonconforming leads to increased polyethylene wear Humeral stem fixation cemented stem or uncemented porous-coated implants position of humeral stem should be 25-45° of retroversion if position of glenoid retroversion is required, then the humeral stem should be less retroverted to avoid posterior dislocation avoid valgus positioning of humeral stem avoid overstuffing the humeral head increases joint reaction forces and tension on the rotator cuff the top of the humeral head should be 5 to 8 mm superior to the top of the greater tuberosity intraoperative humerus fracture greater tuberosity fracture treatment if minimally displaced, insert a standard humeral prosthesis with suture fixation and autogenous cancellous bone grafting of the greater tuberosity fracture humeral shaft fracture treatment remove prosthesis and add longer stem with cement and reinforce with cerclage wiring Rehabilitation Passive or active-assisted motion only during early rehab limiting factor in early postoperative rehabilitation is risk of injury to the subscapularis tendon repair Progress to ER isometrics Limit passive external rotation risk of tear and pull-off of subscapularis tendon from anterior humerus tear leads to anterior shoulder instability (most common form of instability after TSA) treatment of subscapularis pull-off is early exploration and repair of tendon test for pull-off of subscapularis weak belly-press test inability to put hand in back pants pockets or tuck shirt behind the back avoid pushing out of chair during acute rehab IR eccentric and isometric Complications Glenoid loosening most common cause of TSA failure (30% of primary OA revisions) risk factors insufficient glenoid bone stock (posterior glenoid wear associated with glenoid loosening) rotator cuff deficiency 2.9% reoperation rate for loosening (28% with revision) radiographic lines presence of radiographic lines does not correlate with symptoms progression of a radiographic line does correlate with symptoms progression present in 50% of patients as early as 3 to 4 years after TSA radiolucency around the glenoid does not always correlate with clinical failure at 3- and 7-year follow-up did not correlate with poor functional outcomes or pain Vascular injury Arcuate artery, branch off the anterior humeral circumflex artery, can be damaged during biceps tendon elevation Humeral stem loosening more common in RA and osteonecrosis rule out infection Subscapularis repair failure Malposition of components Improper soft tissue balancing failure due to undiagnosed presence of rotator cuff tears Iatrogenic rotator cuff injury/attritional rotator cuff tear can occur if humeral neck osteotomy is inferior to level of rotator cuff insertion overstuffing glenohumeral joint leading to attritional supraspinatus and subscapularis tears common reason for conversion to reverse total shoulder arthroplasty Stiffness Infection may have normal aspiration results culture arthroscopic tissue culture more sensitive (100% sensitive and specific) than fluoroscopically guided aspiration (17% sensitivity, 100% specific) Propionibacterium acnes (P. acnes), now referred to as Cutibacterium acnes (c. acnes) most common cause of indolent infections and implant failures infection rate 1-2% after primary TSA characteristics gram positive, facultative, aerotolerant, anaerobic rod that ferments lactose to propionic acid has high bacterial burden around the shoulder forms biofilm within 18-90h (found on implant surface and on synovial tissue) >> planktonic (explains why aspiration is only 17% sensitive) P. acnes PJI more common in males presentation initial pain & stiffness later swelling & redness diagnosis use anaerobic culture bottles, keep for 10-14days (mean time to detection 6 days) 16s rRNA PCR imaging (XR, CT, ultrasound) positive for subluxation/loosening in 24% of cases if implant is removed, sonicate implant (to dislodge bacteria from surface) for sonication culture treatment early infection (<6 weeks) can be treated with open irrigation and debridement late infection (>6 weeks) should be treated by explant and 2-stage reimplantation after IV antibiotic (penicillin G, ceftriaxone, clindamycin, vanco) x 6wk, followed by 2-6mths of PO antibiotic Neurologic injury axillary nerve is most commonly injured inferior border of subscapularis tendon can be used as a landmark to identify axillary nerve as it courses from anterior to posterior musculocutaneous nerve can be injured by retractor placement under conjoint tendon Periprosthetic fracture acceptable fragment alignment ≤ 20° flexion/extension, ≤ 30° varus/valgus, ≤ 20° rotation malalignment see table below Wright & Cofield Classification of Periprosthetic fracture Type Characteristics Treatment of Intraoperative Fracture Treatment of Postop Fracture Type A Centered near the tip of the stem and extends proximally Span fracture with standard length prosthesis (2-3 cortical diameters) or long-stem prosthesis. Transosseous sutures for tuberosity fractures Usually min displaced/angulated (treat nonop). If significant overlap between prox-distal fragments, treat as if stem loose and revise to long stem prosthesis. Type B Centered at the tip of the stem and extends distally. Span fracture with standard length prosthesis (2-3 cortical diameters) or long-stem prosthesis. Cement in distal canal to engage prosthesis (do NOT let cement escape from fracture site). Cortical strut allograft + cerclage. Revise to long-stem prosthesis. Cement in distal canal to engage prosthesis Type C Located distal to the tip of the stem. Long-stem prosthesis, or if close to olecranon fossa, plate+screws± cerclage wire, strut allograft ORIF (plate overlap prosthesis by 2 cortical diameters to avoid stress riser)
Technique Guide CPT Codes: 23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Total Shoulder Arthroplasty for Arthritis Orthobullets Team Shoulder & Elbow - Glenohumeral Arthritis (Shoulder Arthritis)
QUESTIONS 1 of 42 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ19.65) A 67-year-old woman is to undergo an anatomic total shoulder arthroplasty (TSA). Which of the following characteristics in her preoperative imaging studies (Figures A-D) would most strongly correlate with early loosening of the glenoid component? QID: 213967 FIGURES: A B C D Type & Select Correct Answer 1 Inferior humeral head osteophytes 2% (31/1487) 2 Biconcave native glenoid morphology 67% (1002/1487) 3 Subtle anterior humeral head subluxation 9% (130/1487) 4 Rotator cuff musculature changes 16% (241/1487) 5 Disruption of Shenton's line 5% (75/1487) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ18.104) A 55-year-old male with a history of right shoulder osteoarthritis underwent a total shoulder arthroplasty 7 months ago. The patient now complains of right shoulder pain, instability, and weakness. He denies any falls or other trauma since surgery. Physical exam is notable for weakness with the belly-press test and external rotation of the right shoulder to 110 degrees compared to 80 on the contralateral side. His radiograph is shown in Figure A. What is the likely cause of this patient's symptoms? QID: 213000 FIGURES: A Type & Select Correct Answer 1 Supraspinatus tear 3% (61/2031) 2 Missed intraoperative periprosthetic humeral shaft fracture 1% (17/2031) 3 Glenoid component malpositioning 3% (62/2031) 4 Lesser tuberosity nonunion 80% (1615/2031) 5 Oversizing of the humeral head 13% (259/2031) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ18.107) A 65-year-old male underwent a right total shoulder arthroplasty procedure 5 years ago and is presenting with increasing shoulder pain and weakness. The patient denies any recent falls, fevers, or chills. The patient is unable to abduct the arm beyond 30 degrees but can be assisted passively to 120 degrees. Physical exam demonstrates a positive belly-press test and Jobe's test, but negative Hornblower's test and normal external rotation strength with the arm at the side. Figures A and B are the current radiographs. Current ESR and CRP are 21 mm/hr and 1.2 g/L,respectively. What is the most likely cause of the patient's symptoms and associated risk factor? QID: 213003 FIGURES: A B Type & Select Correct Answer 1 Osteolysis; high congruity of the glenoid component 2% (49/2039) 2 Glenoid component loosening; insufficient bone stock 4% (89/2039) 3 Prosthetic joint infection; male with acne 1% (27/2039) 4 Supraspinatus and subscapularis tear; overstuffing of the glenohumeral joint 72% (1460/2039) 5 Supraspinatus and infraspinatus tear; undiagnosed prior rotator cuff tear 20% (402/2039) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.219) A 78-year-old male presents to clinic 4 weeks after left total shoulder arthroplasty. He has not been wearing his sling and reports that he developed increased pain after slipping in the shower. He used the arm to catch himself from falling. On examination, he can flex the shoulder to 70 degrees, limited by pain. Active external rotation with arm at the side is 50 degrees and active internal rotation is 5 degrees. Passive external rotation is to 80 degrees. A radiograph of the left shoulder is shown below in Figure A. What other complaint is the patient most likely to have? QID: 4854 FIGURES: A Type & Select Correct Answer 1 Pain with palpation of the bicipital groove 9% (355/3740) 2 Pain with palpation over the subdeltoid bursa 5% (182/3740) 3 Sensory loss over the lateral shoulder 3% (125/3740) 4 Sensation of shoulder instability with external rotation 73% (2746/3740) 5 Sensation of shoulder instability with internal rotation 8% (286/3740) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ13.255) A 62-year-old man complains of shoulder pain for 2 years. He has had 1 course of intra-articular sodium hyaluronate and 6 weeks of physical therapy with little relief. Examination reveals diminished arm flexion and abduction secondary to pain. Radiographs of his shoulder are shown in Figures A and B. According to the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines, what is the next best step? QID: 4890 FIGURES: A B Type & Select Correct Answer 1 Humeral head replacement arthroplasty 2% (69/4423) 2 Hemiarthroplasty and ream-and-run glenoid procedure 2% (73/4423) 3 Cuff tear arthropathy (CTA) prosthesis 4% (163/4423) 4 Total shoulder arthroplasty with a metal-backed cemented glenoid component 19% (824/4423) 5 Total shoulder arthroplasty with an all-polyethylene cemented glenoid component 74% (3263/4423) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ12.241) Which of the following preoperative factors is a contraindication to total shoulder arthroplasty? QID: 4601 Type & Select Correct Answer 1 Passive external rotation less than 10 degrees 1% (62/5298) 2 Eccentric posterior glenoid erosion 2% (95/5298) 3 A 2-cm full-thickness supraspinatus tendon tear 19% (998/5298) 4 Inflammatory arthritis 2% (131/5298) 5 A preganglionic brachial plexus injury 75% (3993/5298) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ12.172) In which of the following clinical circumstances would it be appropriate to eccentrically ream the anterior glenoid? QID: 4532 Type & Select Correct Answer 1 72-year-old male undergoing a shoulder arthroplasty due to rotator cuff arthropathy 2% (129/5240) 2 65-year-old female with a glenoid retroversion of 13-degrees undergoing shoulder arthroplasty 39% (2048/5240) 3 70-year-old female with humeral anteversion of 13-degrees undergoing shoulder arthroplasty 7% (359/5240) 4 65-year-old female with glenoid retroversion of 25-degrees undergoing shoulder arthroplasty 43% (2269/5240) 5 59-year-old male with significant glenoid bone stock deficiency and severe osteoarthritis 7% (365/5240) L 5 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.50) Which of the following statements regarding propionibacterium acnes infections after shoulder arthroplasty is incorrect? QID: 3473 Type & Select Correct Answer 1 It is usually associated with fevers 80% (3516/4407) 2 Cultures need to be held for 14 days 7% (317/4407) 3 It colonizes the shoulder at increased rates compared to the knee and hip 5% (214/4407) 4 Men have a higher bacterial burden than females 4% (185/4407) 5 It is an important cause of clinical implant failure 3% (148/4407) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ11.252) During a total shoulder arthoplasty (TSA), which of the following technical maneuvers would most likely place the rotator cuff tendons at risk of injury? QID: 3675 Type & Select Correct Answer 1 Excessive retraction on the deltoid muscle during a delto-pectoral approach 2% (83/4026) 2 Palpation of the rotator cuff insertion prior to humeral head resection 0% (20/4026) 3 A humeral cut with 30 degrees of retroversion 7% (289/4026) 4 Excessive bone removal with the humeral neck osteotomy 75% (3035/4026) 5 A humeral cut with 45 degrees of inclination 14% (559/4026) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.219) A 62-year-old man undergoes a total shoulder arthroplasty for osteoarthritis. He accidently uses his operative arm to rise from a chair 3 weeks after surgery and thereafter complains of anterior shoulder pain. Radiographs are significant for anterior dislocation of the prosthesis. What is the most likely mechanism for this complication? QID: 3032 Type & Select Correct Answer 1 long head biceps rupture 4% (60/1424) 2 supraspinatus rupture 5% (70/1424) 3 subscapularis rupture 87% (1234/1424) 4 infraspinatus rupture 1% (20/1424) 5 labral tear 2% (27/1424) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.24) During the initial rehabilitation phase following total shoulder arthroplasty through a delto-pectoral approach, motion and strengthening are typically restricted because of which factor? QID: 410 Type & Select Correct Answer 1 Protection of the subscapularis tendon 90% (2348/2615) 2 Protect of the supraspinatus tendon 3% (73/2615) 3 Risk of dislocation 6% (152/2615) 4 Risk of loosening 1% (26/2615) 5 Intra-articular effusion 0% (7/2615) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ08.12) The placement of a standard all-polyethylene glenoid component for shoulder arthroplasty is contraindicated in which of the following scenarios? QID: 398 Type & Select Correct Answer 1 Irreparable rotator cuff tear 54% (581/1081) 2 Previous glenoid resurfacing 20% (218/1081) 3 Rheumatoid arthritis 16% (177/1081) 4 Osteoarthritis 1% (6/1081) 5 Osteoporosis 8% (87/1081) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ07.27) Which of the following factors has the greatest influence on early postoperative restrictions following total shoulder arthroplasty through a deltopectoral approach? QID: 688 Type & Select Correct Answer 1 Release of the superior border of the pectoralis 2% (36/1464) 2 Strength of the capsular repair 6% (90/1464) 3 Strength of the subscapularis repair 85% (1244/1464) 4 Presence of glenoid retroversion 3% (38/1464) 5 Quality of the patients' bone 3% (48/1464) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ06.153) A 75-year-old right-hand dominant female has persistent right shoulder pain for the past 5 years. An axial CT scan is shown in the Figure A. If a total shoulder arthroplasty is planned, what other procedure must be performed based on this patient's imaging? QID: 339 FIGURES: A Type & Select Correct Answer 1 rule out infection 4% (50/1252) 2 bone grafting of the glenoid 83% (1041/1252) 3 rotator cuff repair 4% (50/1252) 4 acromioplasty 4% (50/1252) 5 humeral head biopsy 4% (48/1252) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ04.124) A 47-year-old male with a history of a Putti-Platt procedure 20 years ago presents with right shoulder pain with decreased range-of-motion. Radiograph is shown in Figure A. What is the most accurate diagnosis? QID: 1229 FIGURES: A Type & Select Correct Answer 1 Primary osteoarthritis 6% (154/2496) 2 Post-capsulorrhaphy arthropathy 64% (1600/2496) 3 Post-traumatic arthritis 11% (279/2496) 4 Arthritis from poor placement of coracoid transfer 8% (193/2496) 5 Avascular necrosis 10% (251/2496) L 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ04.66) A 72-year-old male who underwent right total shoulder arthroplasty 8 months ago is unable to lift his right hand off his back and has weakness with internal rotation. What is the most likely diagnosis? QID: 1171 Type & Select Correct Answer 1 Brachial neuritis 1% (6/1018) 2 Long head of biceps rupture 0% (3/1018) 3 Subscapularis insufficiency 91% (928/1018) 4 Subscapularis nerve palsy 6% (57/1018) 5 Standard postoperative recovery 2% (19/1018) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic
All Videos (120) Podcasts (2) Login to View Community Videos Login to View Community Videos Critical Concepts in Shoulder & Elbow Surgery Debate: Short Stems in Shoulder Arthroplasty - Oke Anakwenze, MD Oke Anakwenze Shoulder & Elbow - Total Shoulder Arthroplasty 1 week ago 10 views 0.0 (0) Login to View Community Videos Login to View Community Videos Critical Concepts in Shoulder & Elbow Surgery Debate: Stemless Implants in Shoulder Arthroplasty - Robert Gillespie, MD Robert Gillespie Shoulder & Elbow - Total Shoulder Arthroplasty 1 week ago 7 views 0.0 (0) Login to View Community Videos Login to View Community Videos Critical Concepts in Shoulder & Elbow Surgery Waste of Time! Use a Reverse or Implant TSA in Retroversion - Gregory Nicholson, MD Gregory Nicholson Shoulder & Elbow - Total Shoulder Arthroplasty 1 week ago 10 views 0.0 (0) Shoulder & Elbow⎪Total Shoulder Arthroplasty Team Orthobullets 4 Shoulder & Elbow - Total Shoulder Arthroplasty Listen Now 13:51 min 10/15/2019 725 plays 5.0 (3) Question Session⎜Total Shoulder Arthroplasty & TKA Sagittal Plane Balancing Orthobullets Team Shoulder & Elbow - Total Shoulder Arthroplasty Listen Now 49:48 min 11/11/2019 107 plays 0.0 (0) See More See Less