Stemmed total shoulder replacement has been the standard of care in modern shoulder replacement for the last decade or so. A traditional shoulder replacement consists of putting a metal rod (stem) and a metal head in the humerus (upper bone in your arm), and a cup shaped plastic surface on your glenoid (the socket in your shoulder). This ball and socket type replacement requires the existing humeral head be removed so that a stem can be placed in the bone. Removing the head also improves access to the glenoid which makes placing the socket implant easier. An Arthrosurface Shoulder HemiCAP consists of an implant that simply resurfaces the head, instead of removing it, and leaves the remainder of the joint intact. There is no stem, no plastic glenoid implant, so the joint is restored rather than replaced. While plenty of study reports indicate that a stemmed total shoulder provides better pain relief and functional outcomes than a stemmed hemi shoulder replacement (half shoulder replacement), there are other factors that need to be taken into consideration when choosing an option that is best for you.
Today, longer life expectancy, joint deterioration at an earlier age, and the increased functional demands of an active lifestyle, requires a more personalized approach to shoulder replacement. The modern patient may benefit from an alternative to a traditional stemmed replacement especially when you consider that the first implant may not be your last. When you combine increased patient demands, especially for patients under 65 years old, with the overall invasiveness of a stemmed shoulder replacement, the need for an alternative becomes much more obvious. Traditional stemmed replacements remove more bone, placing the implants anatomically is a major technical challenge and normal function is compromised since lifting weights, doing pushups and performing strenuous physical activities are usually not advised.
The 2015 Australian Shoulder Arthroplasty Registry, one of the most important independent sources of implant survivorship, underlines the importance of implant selection, particularly for younger patients: The report showed that the younger the patient age, the higher the revision rate. The Arthrosurface HemiCAP had the lowest 5 Year revision rate across all implant classes on the market. Other hemi resurfacings were over 6 times higher, stemmed hemiarthroplasty was 5 times higher and stemmed total shoulder replacement were 4.8 times higher. Read More.
Based on these differences at the 5 year follow-up mark, implant selection plays an important role when considering which joint replacement option is chosen first, as it may influence the long term management of shoulder arthritis.