-
Discussion:
- see
discussion shoulder arthroplasty
- considered in young pt w/ OA, posttraumatic disorders (w/ no have glenoid involvement nor erosion), AVN, or
massive RTC tear;
- approximate survival rate at 10 years is about 80%;
- need for revision is significantly higher in patients who underwent hemiarthoplasty for trauma rather than for RA;
- upto one half of younger patients undergoing hemiarthroplasty will have subjective or objective unsatisfactory results;
- complications unique to shoulder hemiarthroplasty include erosion of the glenoid which may eventually occur in upto 70% of patients;
- of patients undergoing revision hemiarthroplasty, the vast majority will be performed for a painful glenoid arthritis;
-
indications / inclusion criteria: (for hemiarthroplasty instead of
total shoulder arthroplasty);
- concentric glenoid consisting of eburnated bone
- humeral head needs to be centered in the glenoid preoperatively or at the time of surgery;
- there needs to be less than 25% intraoperative subluxation of the trial humeral component, after soft tissue balancing;
- non concentric glenoid: hemiarthroplasty may still be indicated if the glenoid can be converted to a smooth concentric surface w/ reaming;
- references:
-
Treatment of Glenohumeral Arthritis with a Hemiarthroplasty: A Minimum Five-Year Follow-up Outcome Study.
- Surgical Technique
-
technical considerations:
-
modular head
- note that in choosing a hemiarthroplasty component, it may be useful to select one with a modular head, so that the
the head can be removed if a future glenoid resurfacing procedure is required;
- if the head is not modular, then the entire stem would have to be removed inorder to achieve the necessary exposure for glenoid arthroplasty;
-
biologic glenoid resurfacing
-
Humeral Hemiarthroplasty with Biologic Resurfacing of the Glenoid for Glenohumeral Arthritis.
-
Nonprosthetic glenoid arthroplasty w/ hemiarthroplasty and TSR yield similar outcomes in management of comparable patients w/ glenohumeral DJD
-
references:
-
Acute prosthetic replacement for severe fractures of the proximal humerus.
-
Modular hemiarthroplasty for fractures of the proximal part of the humerus.
-
Bipolar implant shoulder arthroplasty. Long-term results.
-
Total shoulder arthroplasty versus hemiarthroplasty. Indications for glenoid resurfacing.
-
Prosthetic replacement of the proximal humerus.
- Glenoid loosening in total shoulder arthroplasty. JL Franklin et al. J. Arthroplasty. Vol 3. 1988. p 39-46.
-
Bipolar hemiarthroplasty for chronic rotator cuff tear arthropathy
-
Optimizing the Glenoid Contribution to the Stability of a Humeral Hemiarthroplasty without a Prosthetic Glenoid.
-
Humeral Head Replacement for the Treatment of Osteoarthritis.
.......................................... ............................................... ..................................................... ............................................
