Constrained total shoulder arthroplasty. Long-term follow-up observations.

Constrained total shoulder arthroplasty is a salvage procedure for patients with disabling pain and a nonfunctioning rotator cuff mechanism. Considering the advanced pathologic process and severe symptoms of these patients, the results of pain relief are gratifying. Many of the patients have weak or absent deltoid muscles, and active overhead motion is not possible. A method of attaching the metal glenoid to the scapula has been designed to reduce the risk of loosening. However, constrained total shoulder arthroplasty does produce considerable stress on bony attachments. Careful patient selection and an excellent, carefully supervised postoperative rehabilitation program are mandatory for success. Before considering a constrained total joint arthroplasty, the surgeon should carefully assess the patient's needs and consider other less extensive shoulder reconstructions.