Considerable controversy remains in the literature as to whether hemiarthroplasty or total shoulder arthroplasty (TSA) is the better treatment option for patients with shoulder arthritis. Several cohort studies have compared the outcomes of stemmed hemiarthroplasty with those of stemmed TSA and had inconsistent conclusions as to which procedure is best. However, these studies suggest that stemmed TSA provided better functional outcome. 340 CSRA cases were performed between 1987–2003, 218 Hemiarthroplasty – Humeral Surface Arthroplasty (HSA) and 122 TSA. There was very little difference in the functional outcome and pain in patients with and without a glenoid implant early, as well as, later after surgery. Mean post-operative Constant score for TSA was 85.0% (59.8 points) and for HSA patients 86.8% (62.3 points) with no statistically significant differences (t-test, p=0.4821). A highly significant difference between the overall proportions of revised cases was observed, with (21/122) 17.2% and (6/218) 2.8% of TSA and HSA cases revised, respectively (p< 0.0001). Further, HSA prostheses survive significantly longer than TSA prostheses. The difference between the survival curves was highly significant, both in the earlier post-operative period (Wilcoxon’s test, p=0.0053) as well as the later on (Log-rank test, p=0.0028). Long-term survival of total joint replacement is related to polyethylene wear debris, and therefore its use should be avoided if possible. The difference between our series and those with stemmed prostheses may be due to the fact that with surface replacement the normal anatomy for each patient can be mimicked better than with the stemmed prostheses and there is substantially less place for error as in stem positioning, head sizing or wrong version that may lead to glenoid erosion and less favourable result. Our current practice is and we suggest performing Copeland humeral surface replacement without insertion of glenoid prosthesis.

Introduction Pridie and Steadman independently noticed the development of a smooth layer of fibrocartilage when treating exposed subchondral bone in the knee using their techniques of drilling or microfracture respectively. Since 1997, patients presenting to our unit for a Copeland cementless Surface Replacement Arthroplasty (CSRA) with a congruent glenohumeral joint have routinely undergone biological resurfacing of the glenoid using a technique similar to that described by Pridie and Steadman. We present this technique of glenoid resurfacing, the histological and surgical outcomes in a consecutive group of patients.

Methods/Results Between 1987 and 2002, 218 CSRA were performed without replacing the glenoid. From 1997, 133 CSRA have been performed with multiple drilling of the glenoid face with a guide wire through the subchondral bone in to the underlying soft cancellous bone to stimulate bleeding. This causes formation of a fibrocartilaginous layer – biological resurfacing. 9 (6.8%) of the patients with biological resurfacing have subsequently undergone a shoulder arthroscopy for postoperative impingement pain. This allowed us to evaluate the glenoid surface – macroscopically a layer of cartilage was noted in all patients, intraoperative biopsies have confirmed this layer to be fibrocartilage microscopically. In the biological resurfacing group, the mean postoperative Constant score (CS) is 86.9 (age/sex adjusted), with a mean improvement in CS of 71.0. 3 (2.3%) patients have required revision.

Conclusion Our results confirm that glenoid drilling at the time of CSRA leads to the formation of a fibro-cartilaginous layer over the glenoid, with significant improvements in Constant scores and functional outcomes. These results are comparable to other published results for total shoulder replacement with polyethylene resurfacing of the glenoid and better than patients that have undergone stemmed shoulder hemiarthroplasty.