Shoulder Resurfacing

Abstract

Resurfacing is a type of shoulder arthroplasty that involves replacing the humeral joint surface with a metal covering, or cap, thus preserving the bone of the proximal part of the humerus. If the glenoid is also replaced, a current conventional polyethylene glenoid replacement prosthesis or an interposed soft-tissue graft is used. The potential advantages of humeral resurfacing, as compared with conventional shoulder arthroplasty, are: (1) no osteotomy is performed (and thus the head-shaft angle does not have to be addressed); (2) minimal bone resection; (3) a short operative time; (4) a low prevalence of humeral periprosthetic fractures; and (5) ease of revision to a conventional total shoulder replacement, if needed. Outcomes of surface replacement arthroplasty have been comparable with those of arthroplasties with a stemmed prosthesis in numerous short and mid-term follow-up studies. Future studies are required to assess the long-term outcomes of humeral resurfacing and to evaluate alternative surface bearing materials, especially on the glenoid side. Resurfacing appears to be a viable option for shoulder replacement, especially in young patients.

Return to sports after shoulder arthroplasty: a survey of surgeons’ preferences

“…2,12,17 Cementless humeral resurfacing arthroplasty, with or without glenoid resurfacing, has been used as a boneconserving alternative to shoulder hemiarthroplasty or TSA for young patients with glenohumeral arthritis. 1,3,6,11 Comparing allowed return to sports after resurfacing (non-stemmed) and traditional (stemmed) shoulder arthroplasties, we found a slightly higher rate of allowed participation after HHR compared with HHA. This difference is likely attributed to surgeon perception that preservation of proximal humeral bone stock and absence of a stemmed prosthesis may allow safer participation in athletic activities.…”

Management of a periprosthetic fracture after humeral head resurfacing total shoulder replacement: a case report

“…14,15 Resurfacing arthroplasty may offer such benefits as minimal bone resection, technical advantages in proximal humeral deformity, potential for revision to stemmed prostheses at a later date, 13 and in particular, a lower incidence of periprosthetic fractures. 3 One disadvantage of the humeral resurfacing TSA is that the procedure is technically more demanding in the exposure of the glenoid because the humeral head is not resected. 21 Many case reports have discussed the incidence and management of periprosthetic fractures after stemmed TSA, both intraoperatively and postoperatively.…”

“…2,4,5,9,13,16 Some have hypothesized that fractures might be less likely after humeral head resurfacing owing to the maintenance of bone stock and the integrity of the humeral surgical neck. 3 In fact, only one other patient with such a fracture has been reported, which occurred intraoperatively, 20 and the fracture was managed conservatively with a collar and cuff. Nonoperative management of periprosthetic humeral fractures can result in delayed union and shoulder stiffness.…”

“…It is indicated in particular if there is extra-articular deformity of the proximal humerus 6 or previous metal work has been implanted. 3 A minimum amount of bone stock is required for a resurfacing TSA to be performed. 13 It may be impractical in the presence of a large Hill-Sachs lesion.…”

“…13 It may be impractical in the presence of a large Hill-Sachs lesion. 3,21 The prevalence of periprosthetic fractures after TSA is 1.5% to 3% in stemmed prostheses and accounts for 20% of all complications. 13 Risk factors include osteopenia, proximal humeral deformity, complications at operation, and over-reaming of the humeral canal in stemmed protstheses.…”