Total Shoulder Replacement vs Hemiarthroplasty

- Operative Considerations: hemiarthroplasty vs total shoulder arthroplasty:
     - preoperative planning must take the following in consideration: status of rotator cuff, bone stock, asymmetric wear, and type and
               extent of soft tissue contractures;
     - expectations:
            - patients should not generally expect to achieve elevation above 130 deg;
            - patients should also understand that improvements in function will continue for upto 18 months postoperatively;
     - poor prognositic indicators:
            - osseous deficiency of the humeral head or glenoid;
            - non-functioning rotator cuff or deltoid;
            - shoulder instability;
            - previous anterior acromioplasty and excision of the CA ligament;
                    - may allow antero-superior dislocation;
                    - consider reconstruction of the CA ligament and pectoralis transfer during the arthroplasty;
     - examination findings:
            - excessive external rotation:
                    - may indicated deficiency of the subscapularis in which case, the subscapularis may have to be augmented w/ an 
                            Achilles  tendon allograft;
            - restricted external rotation:
                    - may indicated severe wear of posterior glenoid, in which case glenoid may have to be reamed to a more neutral version;
     - glenoid bone loss: (see glenoid component);
           - many pts w/ OA have posterior glenoid bone loss, & pts w/ RA may have central or medial erosion;
           - if posterior glenoid bone loss is present, consider altering amount of humeral retroversion from the normal 35 deg to a less
                     retroverted position;
           - this should prevent posterior instability and eccentric glenoid loosening; 
           - references:
                    - Glenoid bone-grafting in total shoulder arthroplasty.
                    - The Effect of Humeral Component Anteversion on Shoulder Stability with Glenoid Component Retroversion.
     - massive rotator cuff tear:
           - see hemiarthroplasty in the rotator cuff deficient patient
           - references:
                    - Replacement arthroplasty of the rotator cuff deficient shoulder.
                    - Prosthetic replacement of shoulder for the treatment of defects in rotator cuff and the surface of the glenohumeral joint

< hr/> Shoulder Arthroplasty with or without Resurfacing of the Glenoid in Patients Who Have Osteoarthritis.
Primary Hemiarthroplasty for Treatment of Proximal Humeral Fractures.
A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis.
Preoperative Factors Associated with Improvements in Shoulder Function After Humeral Hemiarthroplasty.
Long-Term Follow-up of Shoulder Hemiarthroplasty for Glenohumeral Osteoarthritis

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Sunday, September 8, 2019 5:49 am