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The Journal of Bone and Joint Surgery (American) 83:1814-1822 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Shoulder Hemiarthroplasty for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency

Joaquin Sanchez-Sotelo, MD, PhD, Robert H. Cofield, MD and Charles M. Rowland, MS

Investigation performed at the Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Joaquin Sanchez-Sotelo, MD, PhD
Robert H. Cofield, MD
Charles M. Rowland, MS
Departments of Orthopedic Surgery (J.S.-S. and R.H.C.) and Biostatistics (C.M.R.), Mayo Clinic and Mayo Foundation, 200 First Street S.W., Rochester, MN 55905

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. There is an agreement between Smith and Nephew and Mayo Medical Ventures for royalty payments on some of the implants used in this study.

Background: Hemiarthroplasty for the treatment of shoulders with glenohumeral arthritis and severe rotator cuff deficiency has been reported to provide reasonable clinical results. The purposes of this study were to determine the clinical and radiographic results of hemiarthroplasty for this condition and to identify pathological and technical factors that may influence its outcome.

Methods: Thirty patients (thirty-three shoulders) managed with hemiarthroplasty because of glenohumeral arthritis and a massive, irreparable tear of the rotator cuff were followed for an average of five years (range, two to eleven years). Eight shoulders had undergone a prior acromioplasty and resection of the coracoacromial ligament. A small prosthetic head was used in three shoulders; a medium head, in twenty-six; and a large head, in four. Clinical results were graded according to the limited-goals criteria of Neer et al.

Results: The mean pain score decreased from 4.2 points preoperatively to 2.2 points at the time of the most recent follow-up (p = 0.0001). However, at the time of the most recent follow-up, nine shoulders (27%) had moderate pain at rest (four shoulders) or pain with activity (five shoulders). Mean active elevation improved from 72° (range, 30° to 150°) to 91° (range, 40° to 165°) (p = 0.008). Anterosuperior instability occurred in seven shoulders and was associated with a history of subacromial decompression (p = 0.04). The result was graded as successful for twenty-two shoulders (67%).

Conclusions: Shoulder hemiarthroplasty provides marked pain relief in three-quarters of patients with glenohumeral arthritis and severe rotator cuff deficiency. It is a reconstructive option that provides durable results, but it may be complicated by instability and progressive bone loss.


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