Humeral head replacement versus total shoulder arthroplasty: clinical outcomes--a review

Total shoulder replacement (TSR) has been shown to provide predictable pain relief and functional improvement in patients with glenohumeral degenerative arthritis and an intact rotator cuff. When compared with patients with humeral head replacement (HHR), those with TSR have been reported to have more stability, less pain, and increased motion. However, concerns regarding glenoid loosening and the subsequent possibility of a difficult revision with bony deficits have led many to favor HHR alone. Proponents of HHR regard the glenoid as the "weak link" in TSR and, when weighing their options, consider glenoid resurfacing to be too great a risk. The literature suggests that TSR is the best form of treatment for glenohumeral osteoarthritis, except in certain cases of insufficient glenoid bone stock and irreparable rotator cuff tears. Several recent clinical outcomes studies support this, as they have shown better results after TSR in comparison to HHR. Although the fear of radiographic glenoid component loosening is appropriate, evidence of clinical glenoid loosening is not very common. Currently, glenoid component design, in relation to its articulation with the humeral head, continues to grow and evolve as efforts are focused on changes to decrease the incidence of loosening. In addition, improved surgical techniques of cement pressurization may help to minimize glenoid loosening as well. Thus, it is reasonable to expect that the excellent results currently attainable with TSR may improve.