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Fifth generation surgery

Arthrodesis

Arthrodesis is technically feasible. Here, both the glenoid and humerus are burred down to subchondral bone, and percutaneous screws are placed, backed up with an external fixator. However, the only attempt to this date has been unsuccessful. Such technical feats show a lack of maturity and wisdom on the part of the surgeon.

Rotator cuff repair

Successful rotator cuff repair has been per­formed, but the patient selection is critical. The technique can only be performed on small rotator cuff tears. The tear is assessed and the edges are debrided. The area where the torn-off cuff should insert is then burred down until there is bleeding from the bone surface. The debrided cuff is then impaled with an arthro­scopic staple, which is advanced onto the prepared bed and hammered into the humeral head. At 6 weeks  the  staple  is  retrieved arthroscopically and the cuff assessed to see if healing has occurred. If there is impingement at this stage, subacromial decompression can be carried out.

It must be stressed that this is an unproven technique at this stage with no follow up reports in the literature. The wise surgeon will await the results from those centres pioneering these techniques.

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