TOTAL SHOULDER ARTHROPLASTY VERSUS HEMIARTHROPLASTY: Current Trends*

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Currently, a debate exists regarding the indications for hemiarthroplasty and total shoulder arthroplasty. Several factors are important in making this decision. The goal of this article is to discuss some of the variables related to choosing the appropriate procedure for every patient. In addition, we discuss our approach to various arthritic conditions of the shoulder, the reasoning behind them, and their results. Future work will be necessary before more definitive recommendations can be made, and they may well be different for each individual surgeon.

Section snippets

INTRODUCTION

The goal of this article is to review some of the considerations bearing on the selection of either a hemiarthroplasty (humeral component alone) or a total shoulder arthroplasty (both humeral and glenoid components) in the surgical management of glenohumeral arthritis. We do not deal with the choice of procedure for fracture, because total joint replacement is rarely used in that situation.

The decision is complex and multifactorial. Experts differ on the indications for these procedures. Not

SHOULDER ARTHROPLASTY MECHANICS: AN OVERVIEW

The purpose of shoulder arthroplasty is to restore comfort and function to the glenohumeral joint. Four basic mechanical characteristics are essential: motion, stability, strength, and smoothness. Each of these is commonly compromised in the arthritic shoulder, and can potentially be restored by shoulder arthroplasty. We review these parameters and discuss how their consideration affects the choice of the type of arthroplasty.

CLINICAL AND RADIOGRAPHIC EVALUATION

In general, we perform glenohumeral (or total) shoulder arthroplasty in the great majority of cases of glenohumeral joint disease. However, there are some findings on clinical and radiographic evaluation that argue for the use of a humeral hemiarthroplasty. Some of these include (1) superior displacement of the head relative to the glenoid, (2) massive rotator cuff tear, (3) insufficient glenoid bone to support a glenoid prosthesis, (4) a normal glenoid joint surface, (5) a severely contracted

DISEASE CHARACTERISTICS—OUR DECISION MAKING AND RESULTS

Several different processes can destroy the glenohumeral joint surface. The usual pattern of these diseases influences the type of arthroplasty to be performed. We have patient self-assessment data for many of these conditions using the Simple Shoulder Test, comparing the patient's shoulder function at presentation (Ingo) and following treatment (Outcome).66, 71 The effectiveness of the procedure is reflected by the difference between the Outcome and Ingo. The series of hemi and total shoulder

HEMIARTHROPLASTY VERSUS TOTAL SHOULDER ARTHROPLASTY: LITERATURE REVIEW

Recently, some studies have attempted to compare hemiarthroplasty and total shoulder arthroplasty. Boyd et al14 found in a similar, but unmatched, series comparison that at 44 months' follow-up, hemiarthroplasty and total shoulder arthroplasty produced similar results in terms of functional improvement. Pain relief, range of motion, and patient satisfaction were better with total shoulder arthroplasty than with hemiarthroplasty in the rheumatoid population. Progressive glenoid loosening was

Glenoid Component Loosening

Symptomatic loosening of glenoid and humeral components has been reported with a combined incidence of 3.5% and is a major source of complications associated with total shoulder replacement surgery.8, 16, 27, 45, 49, 55, 73, 75, 76, 82, 86, 97, 103, 104, 106, 108 In fact, prosthetic loosening has the distinction of being the most common problem encountered with total shoulder arthroplasty, representing nearly one third of all complications.5, 6, 8, 9, 14, 16, 17, 19, 21, 27, 34, 37, 39, 43, 45,

CONCLUSION

It is evident that many factors must be considered when choosing the appropriate procedure for a patient with glenohumeral arthritis. The decision between hemiarthroplasty and total shoulder arthroplasty is only one factor. Other factors, such as patient selection, particular anatomy of the patient, skill of the surgeon, details of soft tissue management, specific components used, and quality of fixation, may be as or more important in determining the effectiveness of the result. Only by

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    Address reprint requests to Frederick A. Matsen III, MD, Department of Orthopaedics, University of Washington, Box 356500, 1959 NE Pacific Street, Seattle, WA 98195–6500

    *

    Investigation Performed at the Department Of Orthopaedics, University Of Washington, Seattle, Washington

    *

    Shoulder and Elbow Service, Department of Orthopaedics, University of Washington, Seattle, Washington

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