rheumatoid arthritis, and heart disease treatable. Finally, advances in
chemistry and polymer sciences led to a handful of materials that are used
millions of times every year in our world, including the world’s most
common plastic, polyethylene.
Dr. Neer performed forty-six partial shoulder replacements in the first
ten years, since his 1953 breakthrough. Of those forty-six hemi-
arthroplasties, seven were for osteoarthritis and not for fracture. In his
1963 paper in the journal Surgical Clinics of North America, Charlie Neer
concluded: “The results of prosthetic replacement have been better in this
group than any other.” In the first decade, the father of shoulder surgery
was performing less than one replacement per year for arthritis, but this
number would quickly increase.
In Dr. Neer’s next major shoulder replacement publication,
“Replacement arthroplasty for glenohumeral osteoarthritis,” a twenty-year
report on shoulder replacement, the New York City surgeon reported on
forty-eight patients who had undergone arthroplasty surgery for arthritis.
Therefore, in the first decade of application, seven patients were operated
on for arthritis, but 41 patients were treated in the second decade, an
almost sixfold increase. In the 1974 article, Dr. Neer, once again, gave a
sneak peek into the future. Buried in data table 1 is patient number
eighteen, a fifty-seven-year-old housewife who underwent total shoulder
arthroplasty, with placement of a polyethylene implant on the glenoid, or
shoulder socket side. Dr. Neer explained, “The technique was modified in
this patient by inserting a high-density polyethylene glenoid, anchoring it
with acrylic cement and using a slightly different humeral element.”^4
There is an illustration of the implant, but no X-ray. This “Neer II”
Vitallium implant had been slightly modified by curving the edges and
making the humeral head more spherical, and represents the primogenitor
of all shoulder implants for the next several decades.
Every major orthopedic joint replacement developed since the 1960s
has had three main characteristics in common: a plastic polyethylene
cushion, a metal alloy articulating surface, and acrylic cement to hold the
metal parts in place. Whether a shoulder, elbow, wrist, hip, knee, or ankle
arthroplasty, every joint has been replaced with these three components.
Newer developments have included cementless components where the
texture of the implant causes bone ingrowth without the need for acrylic