Hemi-resurfacing arthroplasty of shoulder

FAQs on Hemi-Resurfacing Arthroplasty of Shoulder

 

Hemi-resurfacing arthroplasty of shoulder is commonly used method to treat shoulder joint problems. Using a partially reconstructive method, the procedure is most suited for younger patients. The three-decade-old surgical intervention has greater potential with advancements in medical technology.

What is hemi-resurfacing arthroplasty of shoulder?

Hemi-resurfacing of shoulder is a type of arthroplasty used to treat a variety of shoulder joint problem. Arthroplasty is surgical reconstruction of a joint. Resurfacing of shoulder is a less invasive surgical procedure to replace the damaged or diseases surface of the joint rather than reconstructing the entire joint using prosthetic implants. The procedure is also called resurfacing hemiarthroplasty.

Thus, hemi-resurfacing arthroplasty of shoulder involves partial reconstruction or replacement of the damaged bone surface in the shoulder joint. The joint surface of the humeral head is attached with a cap-like implant and the stem is allowed to remain as it is. It preserves bone and less traumatic compared to total shoulder replacement used to treat severe arthritis symptoms.

What conditions are treated with hemi-resurfacing arthroplasty of shoulder?

Hemi-resurfacing arthroplasty of shoulder is prescribed to treat conditions, such as

  • Osteoarthritis of the shoulder joint due to degenerative disorders
  • Rheumatoid arthritis leading to chronic inflammation, cartilage loss, pain, and stiffness in shoulder joint
  • Post-traumatic arthritis in shoulder
  • Rotator cuff tear arthropathy causing shoulder joint disorder
  • Avascular necrosis or shoulder joint bone damages due to lack of blood supply
  • Fracture of the shoulder requiring reconstruction of shoulder joint
  • Failed previous shoulder replacement surgery

Who is a candidate for hemi-resurfacing arthroplasty of shoulder?

Patients with following conditions are suggested hemi-resurfacing arthroplasty of shoulder.

  • Excessive pain and bone damage in the shoulder joint
  • No humeral neck fracture
  • No significant damage to glenoid surface cartilage
  • Chance to preserve the humeral bone
  • Patients don’t need total shoulder joint replacement

How hemi-resurfacing arthroplasty of shoulder is different than total resurfacing?

Hemi-resurfacing arthroplasty refers to partial reconstruction of the joint. Only the damaged surface is replaced or reconstructed. Total resurfacing arthroplasty is more comprehensive with the entire joint socket, along with bone stems are replaced.

Hemi-resurfacing arthroplasty retains the chance of a patient undergoing full shoulder replacement, if required, in the future. Its focus on bone conservation enables future surgical shoulder replacement procedures. More bone preserved mean, patients have better stability. Less implant mean less chance of blood loss and infection.

There is no osteotomy. Minimal bone resection assures shorter surgery, reduced risk of periprosthetic fractures, and fast recovery. It is easy to do revision surgery, if required.

How is hemi-resurfacing arthroplasty of shoulder performed?

The patient is put under general anesthesia. Surgeons open the subscapularis tendon using a deltopectoral approach. The shoulder was dislocated anteriorly followed by partial debridement of the labrum. A prosthetic humeral cup-size implant is fixed to the humeral head covering the surface in anatomic version. Subscapularis repair is performed to end the surgery and the joint is bandaged.

The partial reconstruction leaves patients with more bone and option for total shoulder replacement later in case of complete dysfunction of the joint. Studies indicate 85 to 95 percent success rate of hemi-resurfacing arthroplasty of shoulder. The implant may last for 15 to 20 years.

How long it takes to perform hemi-resurfacing arthroplasty of shoulder?

The procedure takes about 2 hours. Patients may be kept under observation for a few hours.

Do I need to stay at the hospital after hemi-resurfacing arthroplasty of shoulder?

Over 90% patients are discharged after an overnight stay. Those without any assistance at home may go for brief hospital stay.

Do I need rest after hemi-resurfacing arthroplasty of shoulder?                                    

The incision on the front shoulder requires you to rest for at least 2 to 3 days until the swelling is stopped. You have to use a sling for the first two weeks to ensure that there is no stress on the shoulder. Doctors may prescribe pain medication for a few weeks. Meet you doctor for a checkup after 7 to 10 days.

What kind of rehabilitation is needed following hemi-resurfacing arthroplasty of shoulder?

The surgery is followed by a structured rehabilitation program custom-made according to patient condition and ability. Gentle exercises, including passive circumduction and pendulums, start on the next day of operation. A few days later, the patient is allowed to have back and forth motion and elbow flexing. However, any external rotation is kept limited to less than 30°. Aggressive physical therapy is resorted to after the 4th week and continues for 3 to 4 months..

What are the recovery period following hemi-resurfacing arthroplasty of shoulder?

Patients recover within 4 to 6 weeks. But complete recovery of shoulder joint takes at least 3 months. You can do desk jobs after the first week, but avoid stress to the shoulder until six weeks.

What are the potential complications of hemi-resurfacing arthroplasty of shoulder?

Pain and temporary stiffness are common symptoms that last for a few days. However, patients are likely to suffer from bleeding, injury, nerve damage, humerus fracture, implant failure, and infection, if a surgeon does not follow the standard surgical procedure.

References

Harlan C. Amstutz, et al. Current Status of Hemi-Resurfacing Arthroplasty for Osteonecrosis of the Hip: A 27-Year Experience. Orthopedic Clinics of North America, April 2009Volume 40, Issue 2, Pages 275–282

Kabata T, et al. Hemi-resurfacing versus total resurfacing for osteonecrosis of the femoral head. J Orthop Surg (Hong Kong). 2011 Aug;19(2):177-80.

Tooke M, et al. Hemiresurfacing for femoral head osteonecrosis. The Journal of Arthroplasty, Volume 2, Issue 2, 1987, Pages 125–133

Shrivastava N et al, Copeland EAS hemi-resurfacing arthroplasty for rotator cuff tear arthropathy: preliminary results. J Surg Orthop Adv. 2009 Winter;18(4):189-94.

Bailie S, Llinas PJ, Ellenbecker TS. Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age. J Bone Joint Surg Am. 2008;90(1):110-117.

McFarland EG. Shrug off shoulder surgery myth, Johns Hopkins study suggests. Available at: www.jhintl.net/news/default.aspx?id=3086. Accessed on Feb. 27, 2009.

Steffee AD, Moore RW. Hemi-resurfacing arthroplasty of the shoulder. Contemp Orthop 1984;9:51-59.

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