There are several surgical options for treatment of osteoarthritis, rheumatoid arthritis, or osteonecrosis in the shoulder. The options include a total shoulder replacement, reverse shoulder replacement, resurfacing procedures, and hemiarthroplasty. Shoulder hemiarthroplasty is a shoulder replacement procedure which involves replacing the broken humeral head with an artificial joint and reconstructing the fractured bone.
Many studies have proven that the revision rate in patients is much higher if shoulder surgery is performed before the patient is 50 years old.
The question is what surgical procedure should the patient undergo. An excellent study reported in the September 2013 edition of Shoulder and Elbow Surgery compared three different shoulder procedures in patients younger than 59 years of age and a second round that was 59 years or older.
Drs. Mark Dillon et. al. reviewed 2,981 patients with an average follow up of 2.2 years and found that the revision rate was twice as high in the patient group that was under age 59. They also found that the highest failure rate was in the patients that underwent a humeral head re-surfacing procedure. The most common reason for revision surgery in the younger patient group, based on the research, was glenoid arthritis or wear. In the older patient group, the most common reason for revision was instability and infection.
The article’s conclusion was that if a patient is younger than 59 years of age and needs surgery because of end stage arthritis in the shoulder joint, a total shoulder replacement would be the best choice.
Avoiding surgery until the patient is older than 59 would be the best case scenario. However if all conservative treatment options have been exhausted moving forward with a total shoulder replacement would be better than a humeral head resurfacing procedure or hemiarthroplasty.