When it comes to shoulder replacement in rheumatoid patients, would you consider total shoulder replacement or a hemiarthroplasty?
JCP: I am going to give you another complex answer. When I started doing shoulder replacement, it was routine to open the shoulder, remove the head, put in a glenoid component, and then fit in whatever humeral component you could. It meant that the shoulders were often very tight by the end of the procedure. Then I became aware that soft-tissue tension was as important in the shoulder as it was in the knee. So I started to try to approach the rheumatoid shoulder in a different way. I would start by doing soft-tissue release. Then I had to decide which size of prosthesis to put in to give the best result. At the end of the 80s, there had been two studies done looking at the range of motion you need for activities of daily living. So I decided that what I wanted to do was to give the patient at least 30 degrees of external rotation, 90 degrees of internal rotation, and 90 degrees of abduction at the end of the procedure. And I found that once I had created a space with the soft-tissue re
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