This video features Dr. Anthony A. Romeo performing a live surgical demonstration of a total shoulder replacement utilizing the right-sided Arthrex Eclipse Shoulder System. The procedure is a stemless total shoulder arthroplasty performed on a patient suffering from severe osteoarthritis, characterized by significant bone deformities and massive inferior osteophytes.

The surgery progresses through several meticulous phases:

• Incision and Exposure: Dr. Romeo begins by marking the surgical site and making a standard deltopectoral incision, carefully identifying the interval between the deltoid and pectoralis major muscles to minimize bleeding and protect surrounding nerve structures.
• Releases and Joint Mobilization: Due to the severe osteoarthritis, a substantial amount of scar tissue must be removed to reestablish a proper motion interface. The subscapularis tendon is carefully isolated and released via a soft tissue peel technique off the lesser tuberosity. Dr. Romeo explicitly notes the location of the axillary nerve to establish a safe operating zone.
• Osteophyte Removal: Large bone spurs (osteophytes) on the humeral head are resected using a curved osteotome and rongeurs to reveal the true anatomic landmarks.
• Humeral and Glenoid Preparation: A precise, freehanded cut is made to remove the damaged humeral head, ensuring the cut is not too steep so it can securely support a stemless prosthesis. On the socket side, all remaining soft tissue is cleared off the glenoid bone. A 3D CT-scan-guided system (VIP guide) is used to align and drill the center peg and peripheral peg holes.
• Implantation: The team harvests cancellous bone slurry to pack into the trial component. A definitive glenoid component is then securely impacted and cemented into place. On the humeral side, a trunion guide is introduced to place anchors into the bone, followed by the insertion and fixation of the 47mm stemless humeral head.
• Soft Tissue Repair and Closure: Joint stability and balanced range of motion are evaluated and confirmed. The subscapularis tendon is reconstructed using a specialized "speed scap" heavy suture repair technique. To minimize the risk of infection, the joint is thoroughly washed with a diluted Betadine solution and treated with vancomycin powder before final layered muscle and skin closure.

Throughout the operation, Dr. Romeo provides highly detailed clinical commentary, explaining the mechanical principles behind choosing a stemless device, sizing nuances, and standard protocols to prevent complications.