Hemiarthroplasty Osteoarthritis

Shoulder Anatomical HemiarthroplastyHemiarthroplasty OAShoulder Resurfacing

 

Advantage

 

Fewer complications than TSR

Simpler procedure

Indicated in younger patient

 

Disadvantages

 

Glenoid wear after hemiarthroplasty

- potential for medial migration & progressive glenoid wear

- revision to TSR almost always alleviates symptoms

 

Hemiarthroplasty V TSR for OA

 

Sandow et al J Should Elbow Surg 1999

- study randomized after inspection of glenoid

- less pain with TSR

- high revision rate in Hemiarthroplasty for glenoid wear over time

- had to cease study as TSR results significantly superior

 

Lo et al JBJS Am 2005

- metanalysis

- TSR superior pain relief / active ROM / patient satisfaction

 

Similar in AVN and fracture

 

Less clear for RA

- risk of glenoid component loosening

 

Hemiarthroplasty + Biological Resurfacing

 

Elhassen et al JBJS Am 2009

- 13 patients average age 34

- glenoid resurfacing with achilles allograft

- 10/13 required revision at average 14 months for pain

- all had glenoid wear with no evidence of allograft

 

Indications Hemiarthoplasty

 

1.  Normal glenoid

- AVN / trauma

- replace glenoid later if needed

- simple procedure for elderly

 

2.  Young patient

 

3.  Glenoid insufficient bone stock

 

Clinical Case

 

Patient with OA treated with Hemiarthroplasty

 

Shoulder Hemiarthroplasty for Osteoarthritis AP

 

The patient developed pain 2 years later

Infection was excluded with blood tests

CT and bone scan indicative of glenoid wear

US demonstrated intact rotator cuff

 

CT Shoulder Hemiarthroplasty for OsteoarthritisBone Scan Shoulder Hemiarthroplasty for Osteoarthritis

 

Revision to TSR

- cemented 3 peg glenoid inserted

- modular body removed to access glenoid

- shorter body used to decrease humeral head height

- intra-operative GT Fracture treated with trauma body and sutures

 

Hemiarthroplasty revised to TSR