Surgical technique for non-restricted total shoulder prosthesis: Under anesthesia, take a semi-supine sitting position ( beach chair position posterior tilt). It is important not to use the anatomic neck of the humerus as the standard for osteoarthritic shoulder, because osteoarthritic shoulder is often associated with the formation of the inferior border of the humeral head and the inversion of the humeral head, so if this standard is used for osteotomy, it may result in a defect of the upper humeral bone and excessive inversion and sinking of the prosthesis. The rotator cuff should be examined for rupture and any repairable tears should be repaired. In patients with severe acromioclavicular arthritis and impingement, acromioclavicular arthroplasty and anterior inferior acromioplasty can be performed simultaneously. a35 humeral neck stem angle, also making the humeral head at an angle of 30a145 (Raph), i.e., 140a40 after surgery, the humeral head is resected using a targeting device, keeping the osteotomy line at 35a35 with the longitudinal axis of the humeral stem, while externally rotating the upper arm by 30. two non-absorbable sutures are used to suture the subscapularis muscle break and hold it medially. The end of the subscapularis is sutured and held medially. The adhesions of the subscapularis to the deep joint capsule are thoroughly separated, and the humeral head and tuberosity are exposed by incising the joint capsule along the anatomic neck of the humerus. The elbow joint is flexed to 90), and a cushion is placed behind the affected shoulder to hold the shoulder forward. The upper extremity of the operated side is draped over the edge of the operating table to ensure that the shoulder can be flexed, extended, and rotated as needed during surgery. The deltoid and pectoralis interosseous sulcus approach is used, and the humeral stop of the deltoid can be partially released if needed, but the clavicular start of the deltoid is not recommended to avoid the loss of muscle strength of the anterior deltoid. The cephalic vein is carefully protected and held laterally along with the deltoid, and the joint tendon is partially held medially. Bluntly separate the adhesions on the deep side of the deltoid. Gently externally rotate the upper extremity and use an electric knife to release 50% to 80% of the humeral attachments of the pectoralis major muscle so that the underside of the glenohumeral joint is more clearly exposed to facilitate identification and protection of the axillary nerve. If the affected shoulder is in severe internal contraction or internal rotation contracture, the pectoralis major muscle can be completely released. The subscapularis tendon is cut 1 cm medial to the humeral tuberosity stop to expose the shoulder capsule. If the internal rotation contracture of the shoulder joint is obvious, the subscapularis muscle should be lengthened in a “Z” shape, so that the subscapularis muscle can be easily externally rotated to 35 after the repositioning of the scapularis muscle. The scapular pelvis is marked with a high speed grinding head to expand the scapular medullary cavity to fit the fixation foot. The glenoid grinder removes the cartilaginous surface of the scapular glenoid to the subchondral bone. The prosthesis is fitted according to the type of glenoid fixation chosen. If the scapular glenoid bone defect is significant and insufficient to support the scapular prosthesis, bone graft repair is required to ensure that the prosthesis is centrally located in the scapular glenoid and has adequate bone support. If the scapular defect is too large to be repaired, an artificial humeral head replacement is an option. After fitting the appropriate size humeral stem and head specimen, repositioning the shoulder joint, and checking the mobility and stability of the shoulder joint, a formal prosthesis is fitted according to the fixation method (bone cement or non-bone cement a35) chosen for the prosthesis. Note that the humeral head prosthesis should be slightly higher than the greater humeral tuberosity to avoid shortening of the upper extremity due to too deep placement of the prosthesis and impingement of the greater humeral tuberosity on the acromion during shoulder abduction. On the first postoperative day, start protected pendulum activities and encourage the patient to use the upper limb on the operated side to gently perform daily movements such as eating and brushing teeth. Functional exercises such as overhead lifting, wall climbing and pulley pulling were started two weeks after surgery. In the seventh week, muscle strength training should be started to encourage the patient to use the shoulder joint normally. It should be emphasized that postoperative shoulder joint functional exercises should be performed under the guidance of a professional physical therapist to avoid inappropriate exercises leading to shoulder joint dislocation. Angle problem shoulder arthroplasty includes artificial humeral head replacement and artificial total shoulder arthroplasty. The artificial humeral head is represented by the Neer type and Biligani type. There are also bipolar humeral head prostheses which are rarely used at present: artificial total shoulder joints are currently divided into non-constrained prostheses, typically Neer type, others are CCLA type, Roper-Day) type and St George type; constrained prostheses, such as MRTS type, Frenlin type, Reeves type, etc.; semi-constrained prostheses, represented by Monospherical type is the representative. Artificial humeral head replacement is suitable for comminuted fractures that are difficult to be repositioned (four-part fractures in Neer’s classification combined with glenohumeral dislocation, humeral head anatomic neck fractures or compression fractures of more than 40%, and comminuted fractures of more than three pieces of the proximal humerus in elderly or severely osteoporotic patients), ischemic necrosis of the humeral head, and tumors of the humeral head; non-constrained artificial total shoulder arthroplasty is suitable for humeral head with The non-constrained total shoulder arthroplasty is suitable for those who have severe lesions of the humeral head, combined with cartilage lesions of the shoulder glenoid but normal rotator cuff function: constrained total shoulder arthroplasty should be considered only when the rotator cuff is out of function or lacks a bony stop for reconstruction. There is still a controversy whether to perform artificial humeral head or total shoulder arthroplasty in patients with glenohumeral arthritis. Generally speaking, total shoulder arthroplasty should be performed as far as possible except for patients with severe loss of shoulder glenoid bone, severe contracture of the shoulder joint or rotator cuff defect that cannot be repaired, primary or secondary osteoarthritis, rheumatoid arthritis, or infectious arthritis (disease at rest for more than 2 months). Patients with Charcol arthropathy are prone to overuse of the affected shoulder due to lack of protective neural reflexes, and patients with rotator cuff arthropathy who are unable to repair the rotator cuff are subjected to eccentric loading from the imbalance of the deltoid-rotator cuff force distance, resulting in a “rocking horse” effect, both of which can easily lead to loosening of the shoulder pelvis prosthesis. Therefore, artificial humeral head replacement was performed. Pre-operative history taking and physical examination should pay attention to the following points: range of motion of the affected shoulder (to determine whether the shoulder is contracture or instability) to determine the soft tissue balance reconstruction and prognosis, functional examination of the rotator cuff (to determine whether to perform rotator cuff repair and total shoulder replacement or humeral head replacement because the rotator cuff cannot be repaired), functional examination of the deltoid muscle (loss of innervation of the deltoid muscle is a contraindication to replacement, axillary nerve, musculocutaneous nerve, and brachial plexus). and brachial plexus (as a control to determine if the nerve is damaged during surgery). The focus of the imaging examination should be on the external rotation (30-40 degrees) radiographs for the measurement of the mold trigger and the selection of the humeral prosthesis type. If necessary, cT or MRI examination was performed. The shoulder was slightly abducted to relax the deltoid muscle in a 30 degree semi-sitting horizontal “beach chair” position. The approach is taken between the deltoid muscle and the pectoralis major muscle. The deltoid muscle is retracted laterally. The joint tendon is medially retracted (or the joint tendon is osteotomized from the root of the rostral process and turned downward), and part of the rostroscapular ligament is severed (all of it can be severed if the rotator cuff is intact), and the upper 1/2 of the pectoralis major tendon is cut if necessary to reveal it. The posterior rotator humeral artery penetrating the inferior 1/3 of the subscapularis is ligated, the subscapularis tendon and joint capsule are cut at about 2 cm medial to the biceps tendon, the shoulder joint is extended in external rotation, the humeral head is cleared, and the upper arm is flexed 90 degrees against the lateral chest wall. The upper arm is flexed by 90 degrees against the lateral chest wall and the upper arm is externally rotated by 25-30 degrees (to correct the posterior inclination of the humeral head), and the neck is osteotomized along the humerus from anterior to posterior in the direction of the template from the proximal side of the supraspinatus stop (to make the neck stem angle); the center of the osteotomy surface is lateralized. The humerus should be grooved along the long axis of the humerus, and the affected limb should be internalized and the marrow expanded. The trial mold is inserted and the prosthesis should completely cover the osteotomy surface with its lateral flanks located just behind the biceps tendon groove (about 12 mm), with the edges immediately behind the attachment point of the joint capsule and slightly overhanging the humeral moment, the trial mold is removed, the shoulder glenoid is exposed, the labrum is excised (pay attention to protect the long head of the biceps tendon immediately above the glenoid lip) and the cartilage of the shoulder glenoid, the joint capsule is loosened, a hole is drilled in the anatomical center of the shoulder glenoid, the middle core of the shoulder glenoid file is inserted into the hole and ground to The subcortical bone is then slotted or drilled depending on the prosthesis fixation method (peg fixation). The prosthesis is installed and adjusted, filled with bone cement, and placed.