الفهرس 
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Abstract
Perhaps the most common reasons to perform a hemiarthroplasty instead of a
TSA remain fear of glenoid component failure and difficulty exposing the glenoid.
However numerous reports in the literature support the superiority of TSA to
hemiarthroplasty for shoulder arthritis.
There are obviously some situations in which a glenoid component cannot be
used such as when there is insufficient bone stock, the rotator cuff is irreparably tom
or very thin, there is a high likelihood that the humeral head will ride high and, in that
situation, we prefer not to use a glenoid component. Many authers demonstrated that
the use of a glenoid component when the bone stock was poor resulted in a high rate
of loosening.
Advocates ofhemiarthroplasty use the argument than glenoid components fail;
they are difficult to revise; and hemiarthroplasty can be later converted to TSA if
necessary. Although some alarming papers on glenoid lucency have been reported,
the rate of revision TSA secondary to glenoid failure remains low. It has been
reported that primary TSA provides significantly better results than conversion of
hemiarthroplasty to TSA. Besides, hemiarthroplasty can cause glenoid erosions that
could potentially be difficult to handle during TSA.
We firmly believe that glenoid replacement performed with meticulous
attention to technique, including the approach, retractor placement, soft tissue
balancing, and cement technique can lead to a successful and enduring solution for the
arthritic shoulder.
Fear of early glenoid loosening in the young patient IS a relative
contraindication of glenoid resurfacing. For such patients who elect to undergo
hemiarthroplasty, we consider the use of biological resurfacing of the glenoid. Early
results with interpositional meniscal allograft have been encouraging.
Humeral resurfacing arthroplasty is a viable treatment option for younger
active patients. Early results indicate that the desired function and pain relief can be expected. Implant loosening and glenoid wear don’t appear to be of concerns in the
short term despite the activity levels in many patiens.But it remains a procedure which
restricted to a narrow range of patients with mild to moderate cases
Successful arthroplasty of the glenohumeral joint in the arthritic patient
depends on an understanding of the disease process and pattern of the disease. An
assessment of the entire patient and strict criteria for the diagnosis of the
glenohumeral joint as source ofthe patient’s symptoms is essential.
The surgical technique necessitates meticulous care of the fragile soft and hard
tissues with careful attention t~ soft tissue release, component orientation, and tissue
balancing. If adhered to, the final result should be satisfying to both patient and the
surgeon.