This retrospective series compares humeral hemiarthroplasty against total shoulder arthroplasty in arthritic shoulders with rotator cuff deficiency. It asks whether resurfacing the glenoid adds any benefit when the cuff cannot be fully reconstructed. The study helps define the role of glenoid resurfacing in this difficult subgroup.
When you face an arthritic shoulder with an irreparable rotator cuff, the question is whether to resurface the glenoid. This paper's answer: usually don't.
The critical mental model is the 'rocking horse glenoid.' A cuff-deficient shoulder lets the humeral head ride superiorly, eccentrically loading the glenoid and rocking it loose over time. Skip the glenoid and you remove that failure mode entirely.
The data show hemiarthroplasty matches total shoulder replacement for pain (95% vs 91%) while gaining far more active elevation (+52° vs +2°) and cutting operative time, blood loss, and hospital stay.
Remember the biomechanical logic: these shoulders have already built a 'new fulcrum' under the coracoacromial arch. Preserve that arch, repair the cuff for anteroposterior stability, and do not force the humerus back down to the glenoid. Frame outcomes with Neer's 'limited goals' category. Success here means pain-free independence in daily tasks, not a normal shoulder.
This retrospective series compares humeral hemiarthroplasty against total shoulder arthroplasty in arthritic shoulders with rotator cuff deficiency. It asks whether resurfacing the glenoid adds any benefit when the cuff cannot be fully reconstructed. The study helps define the role of glenoid resurfacing in this difficult subgroup.
When you face an arthritic shoulder with an irreparable rotator cuff, the question is whether to resurface the glenoid. This paper's answer: usually don't.
The critical mental model is the 'rocking horse glenoid.' A cuff-deficient shoulder lets the humeral head ride superiorly, eccentrically loading the glenoid and rocking it loose over time. Skip the glenoid and you remove that failure mode entirely.
The data show hemiarthroplasty matches total shoulder replacement for pain (95% vs 91%) while gaining far more active elevation (+52° vs +2°) and cutting operative time, blood loss, and hospital stay.
Remember the biomechanical logic: these shoulders have already built a 'new fulcrum' under the coracoacromial arch. Preserve that arch, repair the cuff for anteroposterior stability, and do not force the humerus back down to the glenoid. Frame outcomes with Neer's 'limited goals' category. Success here means pain-free independence in daily tasks, not a normal shoulder.