This is a retrospective case series of humeral hemiarthroplasty for cuff-tear arthropathy. It asks whether replacing only the humeral head, without a glenoid component, can relieve pain and restore function in shoulders with an irreparable cuff tear and destroyed joint surface. The key requirement was a functional deltoid and an intact coracoacromial arch for secondary stability.
When you see an elderly patient with an irreparable massive cuff tear, a destroyed joint surface, and proximal humeral migration, do NOT reach for a total shoulder replacement. The glenoid component loosens because the cuff-deficient head loads it eccentrically, rocking it loose. This paper's core teaching is that a humeral hemiarthroplasty sidesteps that problem entirely.
The procedure only works if two things are intact: the deltoid (the motor) and the coracoacromial arch (the secondary superior stabilizer). If the deltoid is also gone, arthrodesis becomes the fallback. A practical technical pearl: undersize rather than oversize. A tight prosthesis produces posterior capsular tightness and a stiff shoulder, so aim for 50% posterior subluxation intraoperatively.
Historically this work helped define hemiarthroplasty as a reasonable option for cuff-tear arthropathy, predating the reverse total shoulder arthroplasty that now competes for this same indication.
This is a retrospective case series of humeral hemiarthroplasty for cuff-tear arthropathy. It asks whether replacing only the humeral head, without a glenoid component, can relieve pain and restore function in shoulders with an irreparable cuff tear and destroyed joint surface. The key requirement was a functional deltoid and an intact coracoacromial arch for secondary stability.
When you see an elderly patient with an irreparable massive cuff tear, a destroyed joint surface, and proximal humeral migration, do NOT reach for a total shoulder replacement. The glenoid component loosens because the cuff-deficient head loads it eccentrically, rocking it loose. This paper's core teaching is that a humeral hemiarthroplasty sidesteps that problem entirely.
The procedure only works if two things are intact: the deltoid (the motor) and the coracoacromial arch (the secondary superior stabilizer). If the deltoid is also gone, arthrodesis becomes the fallback. A practical technical pearl: undersize rather than oversize. A tight prosthesis produces posterior capsular tightness and a stiff shoulder, so aim for 50% posterior subluxation intraoperatively.
Historically this work helped define hemiarthroplasty as a reasonable option for cuff-tear arthropathy, predating the reverse total shoulder arthroplasty that now competes for this same indication.