From the Guidelines
Total shoulder arthroplasty (TSA) is recommended over hemiarthroplasty for patients with glenohumeral osteoarthritis (GH OA) due to better pain relief and lower revision rates. According to a study published in The Journal of the American Academy of Orthopaedic Surgeons 1, TSA showed statistically significantly better global health assessment scores and pain relief compared to hemiarthroplasty. The study also reported that 14% of patients treated with hemiarthroplasty required revision to TSA due to progressive glenoid arthrosis and pain, whereas no TSA required revision to hemiarthroplasty.
Key Considerations
- TSA typically provides better pain relief and functional outcomes compared to hemiarthroplasty
- Hemiarthroplasty may be more appropriate in specific situations, such as young, active patients with intact glenoid cartilage or cases with severe glenoid bone loss
- The decision between TSA and hemiarthroplasty should consider the patient's age, activity level, bone quality, rotator cuff integrity, and glenoid morphology
- TSA generally requires more surgical expertise and carries slightly higher risks of glenoid loosening, while hemiarthroplasty may lead to glenoid erosion over time, potentially necessitating revision surgery
Outcomes and Risks
- TSA has been shown to have lower revision rates compared to hemiarthroplasty, with approximately 0-1.2% per year risk of glenoid loosening 1
- Hemiarthroplasty may lead to glenoid erosion over time, potentially necessitating revision surgery, with approximately 14% of patients requiring revision to TSA 1
- Recovery protocols are similar for both procedures, typically involving 4-6 weeks of protected motion followed by progressive strengthening over 3-4 months
From the Research
Total Shoulder Arthroplasty vs Hemi
- Total shoulder arthroplasty (TSA) and hemiarthroplasty are two types of shoulder replacement surgeries, with TSA involving the replacement of both the humeral head and the glenoid, while hemiarthroplasty involves the replacement of only the humeral head 2, 3, 4.
- The indications for TSA and hemiarthroplasty include glenohumeral osteoarthritis, inflammatory shoulder arthropathies, rotator cuff-tear arthropathy, complex fractures of the proximal humerus, and osteonecrosis of the humeral head 2, 3, 4.
- TSA seems to provide the best outcome for patients with osteoarthritis and inflammatory arthropathy, while the outcome of hemiarthroplasty for proximal humerus fractures is somewhat unpredictable 4.
- The results of shoulder arthroplasty vary depending on the underlying diagnosis, the condition of the soft-tissues, and the type of reconstruction 4.
- Reverse shoulder arthroplasty has become extremely popular for patients with cuff-tear arthropathy, and its indications have been expanded to the field of revision surgery 4.
- Physical therapy is considered routine practice following TSA, with evidence suggesting that early physical therapy may promote a more rapid return of short-term improvement in function and pain 5.
- TSA leads to significant improvements in scores for function and pain, with shoulder-specific measures of function consistently showing the greatest degree of improvement 6.