This multicenter retrospective study compared outcomes of 601 TSAs versus 89 hemiarthroplasties for primary glenohumeral osteoarthritis across 55 European centers. Patients were evaluated with the Constant score, range of motion, patient satisfaction, and radiographic findings at a minimum 2-year follow-up. At 690 shoulders, it was the largest direct comparison of the two procedures for a single diagnosis at the time of publication.
For years, the debate over glenoid resurfacing centered on one fear: loosening. Prior studies, including Gartsman's 47-patient RCT, simply lacked the power to show statistically significant differences in objective outcomes like Constant score and range of motion.
This paper closes that debate. When a patient with primary glenohumeral OA has adequate glenoid bone stock and an intact (or small, reparable) rotator cuff, resurface the glenoid. The functional gains are real, statistically robust across every subgroup, and unaccompanied by any increase in complication rate.
Do not let the 57% radiolucency rate on postoperative films alarm you or your patient. Only 2% of TSA shoulders required revision for glenoid loosening, and the poor survivorship curve in this series traces almost entirely to one discontinued implant design (metal-back cementless glenoid). Modern all-polyethylene cemented components do not carry that failure burden.
The two clear contraindications to glenoid resurfacing remain: inadequate glenoid bone stock and a massive irreparable rotator cuff tear. Outside those two scenarios, the evidence consistently favors TSA.
This multicenter retrospective study compared outcomes of 601 TSAs versus 89 hemiarthroplasties for primary glenohumeral osteoarthritis across 55 European centers. Patients were evaluated with the Constant score, range of motion, patient satisfaction, and radiographic findings at a minimum 2-year follow-up. At 690 shoulders, it was the largest direct comparison of the two procedures for a single diagnosis at the time of publication.
For years, the debate over glenoid resurfacing centered on one fear: loosening. Prior studies, including Gartsman's 47-patient RCT, simply lacked the power to show statistically significant differences in objective outcomes like Constant score and range of motion.
This paper closes that debate. When a patient with primary glenohumeral OA has adequate glenoid bone stock and an intact (or small, reparable) rotator cuff, resurface the glenoid. The functional gains are real, statistically robust across every subgroup, and unaccompanied by any increase in complication rate.
Do not let the 57% radiolucency rate on postoperative films alarm you or your patient. Only 2% of TSA shoulders required revision for glenoid loosening, and the poor survivorship curve in this series traces almost entirely to one discontinued implant design (metal-back cementless glenoid). Modern all-polyethylene cemented components do not carry that failure burden.
The two clear contraindications to glenoid resurfacing remain: inadequate glenoid bone stock and a massive irreparable rotator cuff tear. Outside those two scenarios, the evidence consistently favors TSA.