Decision Making in Contemporary Shoulder Arthroplasty
When do you replace the
glenoid?
Michael A. Wirth, M.D.
University of Texas Health Sciences
Center
San Antonio
Disclosure

DePuy Johnson & Johnson company

The author did not receive any outside funding or
grants in support of the research for or preparation
of this work.
“Sometimes the realization that
both sides are in the dark is the
1st step toward understanding.”
Long-term problems, such as loss of bone
stock, polyethylene wear debris, and
loosening of the glenoid component have
important implications…
Total Shoulder Arthroplasty
Versus Hemiarthroplasty
Indications for Glenoid Resurfacing
Allen Boyd, William Thomas, Richard Scott, Clement Sledge, &
The Journal of Arthroplasty 1990
Thomas Thornhill
146 TSA & 64 HA (Neer design)
 RA, OA,AVN…
 44 month f/u (range, 24-124)
 Pain relief, ROM, satisfaction better with
TSA in RA ( although not statistically sig.)

Shoulder Arthroplasty with or without
Resurfacing of the Glenoid in Patients who
have Osteoarthritis
Gartsman GM. Roddey TS and Hammerman SM
J Bone Joint Surg 2000
51 shoulders ( 27 TSA & 24 HA )
 35 month f/u ( range, 24 to 72 )
 TSA provided significantly greater pain
relief and internal rotation
 Pt satisfaction, function, and strength also
superior but none of these differences were
found to be significant

Hemiarthroplasty for glenohumeral
osteoarthritis: Results correlated to
degree of glenoid wear
Levine WN, Djurasovic M, Glasson J, Pollock RG, Flatow EL & Bigliani
LU
J Shoulder Elbow Surg
1997
31 shoulders
 29 month f/u ( range, 14 to 72 )
 86% satisfactory when glenoid was
concentric and 63% when nonconcentric

Treatment of Glenohumeral Arthritis with a
Hemiarthroplasty: A Minimum Five-Year
Follow-up Outcome Study
Wirth MA, Rockwood CA, Tapscott RS, and Southworth C
J Bone Joint Surg 2006
64 shoulders (57 patients)
 Mean age 63 years (range, 44-78)
 Results were compared at 2 years and at 7.5
years
 All changes were small in terms of clinical
importance

Biconcave
20 degrees
When is a hemiarthroplasty
appropriate?
When the glenoid cartilage is intact &
concentric
 When there is insufficient bone to support a
glenoid component
 When force couples are balanced in a
shoulder with CTA

Viable articular cartilage…
Glenoid insufficiency…
6 o’clock
12 o’clock
Cuff Tear Arthropathy
Selection Criteria
1)
2)
3)
4)
5)
>90 degrees elevation
negative lag sign
4+ strength
Negative Hornblower’s sign
Negative lift-off
Superior migration of the
humeral head…
“Rocking Horse
effect”
Still weak and
Still unstable!
In younger patients with an intact
glenoid…
When used in conjunction with a soft tissue
interpositional graft in a younger patient…
6 month post op
HH
Glenoid
At this point the literature
comparing HA and TSA seems to
favor the former when…

Hemiarthroplasty
1) Young active
patients with
intact glenoid
2) Insufficient bone
3) Acute fractures
4) CTA with balanced
force couples

Total Shoulder A-plasty
1) Osteoarthritis
2) Rheumatoid arthritis
with an intact cuff
3) Incongruency of the
glenoid
4) Adequate glenoid
bone stock
Patient selection is key!
“Do not be wedded to one
method, the good surgeon, like
the good golfer, has many
clubs in his bag and goes to
great pains to use the correct
one for each shot.”
Harold Boyd
Thank you!