Shoulder Hemiarthroplasty With Nonprosthetic Glenoid Arthroplasty

Shoulder arthroplasty offers patients with glenohumeral arthritis the opportunity to regain comfort and function. Current approaches to the humeral side of the arthritic shoulder offer the patient and the surgeon robust and durable methods for anatomic positioning and fixation of a smooth and unwearing joint surface. Although humeral hemiarthroplasty can provide good results, there is some evidence that the comfort and function is less than a successful total shoulder arthroplasty. Problems with prosthetic glenoid components are loosening and wear; which now represent the dominant modes of failure of total shoulder arthroplasty. Attempts to solve the glenoid problem with interposed autograft or allograft materials have yet to provide satisfactory results in most cases. For these reasons, there has been an interest in combining a humeral hemiarthroplasty with a nonprosthetic approach to the glenoid side of the arthritic shoulder avoiding the risks associated with glenoid components and allowing unrestricted activity. In this approach, the arthritic glenoid is contoured by reaming to a concavity slightly larger in diameter than that of the humeral component. The purpose of this paper is to document the refinements in patient selection, surgical technique, and postoperative care that appear to optimize the results of this procedure.