Monday, April 14, 2014

Humeral resurfacing arthroplasty problems

Today in the office we're seeing two patients with unsatisfactory results after a hemicap resurfacing arthroplasty. Each had an Simple Shoulder Test score of only 1/12 positive responses.
A review of the cases show the difficulty in the placement of the prosthesis as well as the unresolved glenoid pathoanatomy.

Case 1 - clinical exam suggests failure of the subscapularis as well as stiffness. Note the varus position of the component.

Case 2 - Note the large amount of residual humeral neck resulting in 'overstuffing' of the joint.

The purpose of this post is not to state that humeral resurfacing is a bad operation; any surgery can have problems. The point is that (1) a humeral resurfacing is a technically challenging procedure, (2) that reconstructing the anatomy is not trivial, and (3) humeral resurfacing does not manage the glenoid side of glenohumeral arthritis. In such cases, it may not be a 'conservative' approach.

Both of these cases require surgical revision because of pain and stiffness that has not responded to non-operative management.


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