Historically, the decision to perform a hemiarthroplasty (HHR) versus a total shoulder arthroplasty (TSA) is based on the status of the glenoid and the status of the soft tissues (rotator cuff). In disease processes where the glenoid articular cartilage is relatively well preserved such as avascular necrosis and complex proximal humerus fractures, most orthopaedists recommend performing a HHR while preserving the native glenoid articular surface. At the other end of the spectrum, if the glenoid has excessive bone loss or is unreconstructible, a HHR is the preferred procedure. In patients who have deficient so(t-tissues (rotator cuff) such as rotator cuff tear arthropathy and, occasionally, rheumatoid arthritis, a HHR is the procedure of choice. The indications for HHR in osteoarthritis remain somewhat controversial. There is mounting evidence that performing a HHR for osteoarthritis is inferior to TSA. Recent developments, or 'third generation techniques and materials', in shoulder arthroplasty are expected to improve the longevity of TSA, particularly the glenoid component. In addition, newer designs of reverse-ball prostheses are entering the market with promising early results in patients with deficient rotator cuff mechanisms.

This prospective clinical study evaluates the 5-10 year results of the BiPolar shoulder Arthroplasty in patients with end-stage RotatorCuff Arthropathy. The study group consisted of 48 patients (59 shoulders). Average age was 72 years and average FU time was 73 months. Results showed that the average UCLA score went from 7.9 Pre-op to 23.3 Post-op. Final Constant score averaged $52\% (unadjusted). Pain relief using the VAS was 1.2(were 0=no pain. 15 = excruciating pain). ROM improved by an average of $20^\circ$. There were 2 reoperations because of periprosthetic fractures. Despite rather poor functional results, these patients were satisfied with their pain relief and the functional gains accompanying pain relief would be an added benefit.

[ ${\cdot}$ ] Instability in the overhead athlete complicated ${\cdot}$ Consider other pathologies: Internal Impingement SLAP ${\cdot}$ Diagnose by Hx, Px, MRI, EUA, and arthroscopy

This is a prospective study in which we evaluate the 5-10 year results of BiPolar shoulder arthroplasty in 64 patients (71 shoulders) with primary glenohumeral osteoarthritis. Fifty two patients (56 shoulders) were followed for greater than 60 months (average 79months)1 and no patients were lost to follow Lip. The average age of the patient at operation was 72.5 years. The UCLA score increased from 10.8 preoperatively to 25,7 postoperatively. The final Constant score in this elderly subset of patients averaged $65\%$ (unadjusted). Eighty seven percent of patients were satisfied with their final result. Excellent pain relief was achieved with a VAS of 2.5 (0=no pain, 15=excruciating pain). Active anterior forward flexion improved from $45^{\circ}$ to $104^{\circ}$. Seventy five percent of patients reveal persisting head-shell motion at an average of 7 years. There were two reoperations because of humeral stem loosening; both stems should have been cemented at the initial arthroplasty. It is demonstrated that BiPolar shoulder arthroplasty is durable over time, with clinical results equivalent to that in the literature when compared with hemiarthroplasty and total shoulder replacement.

1. Direct repair of massive rotator cuff tear is doable. 2. Clinical results of direct repair of massive rotator cuff tear was satisfactory. 3. Function of the deltoid is one of the most important factors to get good clinical results.

Total elbow prostheses which are now available in clinical use can generally be classified into two major categories ; one bing linked prostheses, another being unlinked prostheses. Of those two categories I am dealing here only with the problems of the unlinked type prosthesis, particularly with those of non-constrained, surface-replacement prostheses. Furthermore, my presentations this time may have to be narrowed down only to the topics regrading the particular features and some of the technical problems with Kudo Elbow Prosthesis, due to the time limit assigned for this presentation.

. Open posterior capsulolabral reconstruction(PCLR) in posterior subluxation yields very excellent clinical results if it is positional. . The main pathologic lesion is an excessive redundancy of the posteroinferior capsule. . The muscular type of posterior instability is contraindicated in PCLR.

Properly selected pts Advantages : Limited skin incision & soft tissue dissection Better definition of pathology Tolerable aggressive P.T. Technically Demanding