Neer's 1974 case series reports outcomes of 48 shoulders in 47 patients treated with Vitallium humeral-head hemiarthroplasty for glenohumeral OA at Columbia-Presbyterian (1953–1973). It asks whether replacement arthroplasty can reliably relieve pain and restore function, how durable the prosthesis is at long-term follow-up, and whether glenoid resurfacing is necessary.
Before this paper, glenohumeral OA was considered uncommon, poorly characterized, and without a reliable surgical solution — arthrodesis was a competing option, and joint debridement was attempted despite lack of evidence.
This paper is why we operate on glenohumeral OA with arthroplasty rather than debridement: Neer showed debridement failed in every patient who had it, while hemiarthroplasty succeeded in 87% at 6 years with zero hardware failure at up to 20 years.
When counseling a patient before shoulder arthroplasty, cite Neer: expect excellent pain relief, but warn that strength recovery is slow and overhead fatigability may persist. This has not changed fundamentally in 50 years.
Neer's observation that a flattened glenoid creates prosthetic head excursion and reduced mechanical advantage is the biomechanical rationale for glenoid resurfacing. It explains why modern anatomic total shoulder arthroplasty (TSA) outperforms hemiarthroplasty for pain relief in patients with significant glenoid involvement. A concept traced directly to this paper.
Neer's 1974 case series reports outcomes of 48 shoulders in 47 patients treated with Vitallium humeral-head hemiarthroplasty for glenohumeral OA at Columbia-Presbyterian (1953–1973). It asks whether replacement arthroplasty can reliably relieve pain and restore function, how durable the prosthesis is at long-term follow-up, and whether glenoid resurfacing is necessary.
Before this paper, glenohumeral OA was considered uncommon, poorly characterized, and without a reliable surgical solution — arthrodesis was a competing option, and joint debridement was attempted despite lack of evidence.
This paper is why we operate on glenohumeral OA with arthroplasty rather than debridement: Neer showed debridement failed in every patient who had it, while hemiarthroplasty succeeded in 87% at 6 years with zero hardware failure at up to 20 years.
When counseling a patient before shoulder arthroplasty, cite Neer: expect excellent pain relief, but warn that strength recovery is slow and overhead fatigability may persist. This has not changed fundamentally in 50 years.
Neer's observation that a flattened glenoid creates prosthetic head excursion and reduced mechanical advantage is the biomechanical rationale for glenoid resurfacing. It explains why modern anatomic total shoulder arthroplasty (TSA) outperforms hemiarthroplasty for pain relief in patients with significant glenoid involvement. A concept traced directly to this paper.