This review maps the three shoulder arthroplasty types to specific diagnoses. It covers hemiarthroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty, plus resurfacing and biologic glenoid options. Treatment algorithms guide prosthesis selection by cuff status, glenoid bone stock, and prior arthroplasty failure.
Match the prosthesis to the pathology, and the single most important variable is rotator cuff status. Intact cuff with glenohumeral OA and adequate glenoid bone means TSA. The meta-analysis data are clear: better pain, motion, satisfaction, and fewer revisions than hemiarthroplasty.
Cuff-deficient shoulder with pseudoparesis (active elevation under 90°) means reverse TSA. It restores a stable fulcrum by medializing the center of rotation so the deltoid can elevate the arm, but counsel patients that complication rates run higher than standard TSA.
Reserve hemiarthroplasty for cases where the glenoid cannot be resurfaced: inadequate glenoid bone stock, or a young high-demand patient in whom polyethylene wear is the greater long-term threat. Remember that glenoid arthrosis is the leading reason these later fail.
A practical pearl for the OITE: a nonconcentric or posteriorly worn glenoid predicts poor hemiarthroplasty outcomes, and revision surgery of any kind underperforms primary arthroplasty.
This review maps the three shoulder arthroplasty types to specific diagnoses. It covers hemiarthroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty, plus resurfacing and biologic glenoid options. Treatment algorithms guide prosthesis selection by cuff status, glenoid bone stock, and prior arthroplasty failure.
Match the prosthesis to the pathology, and the single most important variable is rotator cuff status. Intact cuff with glenohumeral OA and adequate glenoid bone means TSA. The meta-analysis data are clear: better pain, motion, satisfaction, and fewer revisions than hemiarthroplasty.
Cuff-deficient shoulder with pseudoparesis (active elevation under 90°) means reverse TSA. It restores a stable fulcrum by medializing the center of rotation so the deltoid can elevate the arm, but counsel patients that complication rates run higher than standard TSA.
Reserve hemiarthroplasty for cases where the glenoid cannot be resurfaced: inadequate glenoid bone stock, or a young high-demand patient in whom polyethylene wear is the greater long-term threat. Remember that glenoid arthrosis is the leading reason these later fail.
A practical pearl for the OITE: a nonconcentric or posteriorly worn glenoid predicts poor hemiarthroplasty outcomes, and revision surgery of any kind underperforms primary arthroplasty.