- 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.
- 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.
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