This randomized trial asked whether resurfacing the glenoid actually helps in primary shoulder osteoarthritis. Forty-seven patients (51 shoulders) with an intact rotator cuff and a concentric glenoid were randomized to total shoulder arthroplasty or hemiarthroplasty by the same surgeon with the same humeral implant. Outcomes were measured with UCLA and ASES scores at a mean of 35 months.
For primary glenohumeral OA with an intact cuff and a concentric glenoid, resurface the glenoid: TSA gave significantly better pain relief and internal rotation than hemiarthroplasty.
The mental model is straightforward. Leaving an arthritic glenoid unresurfaced means the humeral head keeps grinding against it. This trial showed progressive joint-space narrowing in 14 of 24 hemiarthroplasty shoulders, and that erosion is what drove 3 of them to revision within four years.
Weigh cost honestly. Glenoid resurfacing adds roughly $1177 up front, but revising a failed hemiarthroplasty averaged $15,998, so the cheaper index operation is not necessarily the cheaper episode of care.
Appraise the evidence carefully. This is a well-designed single-surgeon RCT, but it never reached its target of 35 per group, so several TSA advantages (satisfaction, function, total score) trended positive without reaching significance. Read those as probably real but underpowered, not as proof of equivalence.
Also remember what TSA trades away: glenoid component loosening is the major long-term complication, so the decision is short-term pain relief against long-term glenoid durability.
This randomized trial asked whether resurfacing the glenoid actually helps in primary shoulder osteoarthritis. Forty-seven patients (51 shoulders) with an intact rotator cuff and a concentric glenoid were randomized to total shoulder arthroplasty or hemiarthroplasty by the same surgeon with the same humeral implant. Outcomes were measured with UCLA and ASES scores at a mean of 35 months.
For primary glenohumeral OA with an intact cuff and a concentric glenoid, resurface the glenoid: TSA gave significantly better pain relief and internal rotation than hemiarthroplasty.
The mental model is straightforward. Leaving an arthritic glenoid unresurfaced means the humeral head keeps grinding against it. This trial showed progressive joint-space narrowing in 14 of 24 hemiarthroplasty shoulders, and that erosion is what drove 3 of them to revision within four years.
Weigh cost honestly. Glenoid resurfacing adds roughly $1177 up front, but revising a failed hemiarthroplasty averaged $15,998, so the cheaper index operation is not necessarily the cheaper episode of care.
Appraise the evidence carefully. This is a well-designed single-surgeon RCT, but it never reached its target of 35 per group, so several TSA advantages (satisfaction, function, total score) trended positive without reaching significance. Read those as probably real but underpowered, not as proof of equivalence.
Also remember what TSA trades away: glenoid component loosening is the major long-term complication, so the decision is short-term pain relief against long-term glenoid durability.