Total Shoulder Arthroplasty is associated With Less Pain and Better Functional Outcomes, but Humeral Head Resurfacing may be Preferred in Younger, Higher Demand Patients: A Short-Term Outcomes Study in Patients with Glenohumeral Osteoarthritis

Document Type : RESEARCH PAPER


1 Freddie Fu Sports Medicine Center- University of Pittsburgh Medical Center, Pittsburgh, PA, USA

2 Summit Health Orthopaedics, Florham Park, NJ, USA

3 Hospital for Special Surgery, New York, NY, USA

4 Rothman Orthopaedics, Orlando, FL, USA



Objectives: This study aimed to compare short-term outcomes following Total Shoulder Arthroplasty 
(TSA) and Humeral Head Resurfacing (HHR) in patients with glenohumeral osteoarthritis (GHOA).
Methods: A retrospective analysis included patients who had undergone either TSA or HHR for GHOA at a single 
institution. Baseline demographics, complications, range of motion (active forward flexion, FF and active external 
rotation, ER), visual analog scores (VAS), and Subjective Shoulder Values (SSV) were collected.
Results: A total of 69 TSA and 56 HHR patients were analyzed. More HHR patients were laborers (44% versus 
21%, P=0.01). There were more smokers in the TSA group (25% versus 11%, P=0.04) and more cardiovascular 
disease in the HHR cohort (64% versus. 6%, p<0.0001). Postoperative FF was similar, but ER was greater in the 
HHR (47° ± 15°) vs. TSA group (40° ± 12°, P = 0.01). VAS was lower after TSA vs. HHR (median 0, IQR 1 versus 
median 3.7, IQR 6.9, p<0.0001), and SSV was higher after TSA (89% ± 13% vs. 75% ± 20% after HHR; p<0.0001). 
Post-operative impingement was more common after HHR (32% vs. 3% for TSA, p<0.0001). All other complications 
were equivalent.
Conclusion: While younger patients and heavy laborers had improved ER following HHR, their pain relief was 
greater after TSA. Decisions on surgical technique should be based on patient-specific demographic and anatomic 
 Level of evidence: III


Main Subjects

1. Ansok CB, Muh SJ. Optimal management of glenohumeral 
osteoarthritis. Orthop Res Rev. 2018; 10:9-18. 
2. Fourman MS, Beck A, Gasbarro G, Irrgang JJ, Rodosky MW, Lin 
A. Humeral head resurfacing is associated with less pain and 
clinically equivalent functional outcomes compared with 
stemmed hemiarthroplasty at mid-term follow-up. Knee Surg 
Sports Traumatol Arthrosc. 2019; 27(10):3203-11. 
3. Ibounig T, Simons T, Launonen A, Paavola M. Glenohumeral 
osteoarthritis: an overview of etiology and diagnostics. Scand 
J Surg. 2021; 110(3):441-51. 
4. Millett PJ, Horan MP, Pennock AT, Rios D. Comprehensive 
Arthroscopic Management (CAM) procedure: clinical results 
of a joint-preserving arthroscopic treatment for young, active 
patients with advanced shoulder osteoarthritis. Arthroscopy. 
2013; 29(3):440-8. doi:10.1016/j.arthro.2012.10.028.
5. Mitchell JJ, Warner BT, Horan MP, et al. Comprehensive 
Arthroscopic Management of Glenohumeral Osteoarthritis: 
Preoperative Factors Predictive of Treatment Failure. Am J 
Sports Med. 2017; 45(4):794-802. 
6. Skelley NW, Namdari S, Chamberlain AM, Keener JD, Galatz LM, 
Yamaguchi K. Arthroscopic debridement and capsular release 
for the treatment of shoulder osteoarthritis. Arthroscopy. 
2015; 31(3):494-500. doi:10.1016/j.arthro.2014.08.025.
7. Okoroha KR, Muh S, Gabbard M, et al. Early outcomes of 
shoulder arthroplasty according to sex. JSES Open Access. 
2019; 3(1):43-7. doi:10.1016/j.jses.2018.12.001.
8. Chalmers PN, Salazar DH, Romeo AA, Keener JD, Yamaguchi K, 
Chamberlain AM. Comparative Utilization of Reverse and 
Anatomic Total Shoulder Arthroplasty: A Comprehensive 
Analysis of a High-volume Center. J Am Acad Orthop Surg. 
2018; 26(24):e504-e10. doi:10.5435/jaaos-d-17-00075.
9. Johnson CC, Johnson DJ, Liu JN, et al. Return to sports after 
shoulder arthroplasty. World J Orthop. 2016; 7(9):519-26. 
10. Ma GC, Bradley KE, Jansson H, Feeley BT, Zhang AL, Ma CB. 
Surgical Complications after Reverse Total Shoulder 
Arthroplasty and Total Shoulder Arthroplasty in the United 
States. J Am Acad Orthop Surg Glob Res Rev. 2021; 5(7). 
11. Gregory TM, Boukebous B, Gregory J, Pierrart J, Masemjean E. 
Short, Medium and Long Term Complications After Total 
Anatomical Shoulder Arthroplasty. Open Orthop J. 2017; 
11:1133-41. doi:10.2174/1874325001711011133.
12. Ross BJ, Wu VJ, McCluskey LC, O'Brien MJ, Sherman WF, 
Savoie FH. Postoperative complication rates following total 
shoulder arthroplasty (TSA) vs. reverse shoulder 
arthroplasty (RSA): a nationwide analysis. Seminars in 
Arthroplasty: JSES. 2020:83-8. doi: 10.1053/j.sart.2020.05.006.
13. Ravi V, Murphy RJ, Moverley R, Derias M, Phadnis J. Outcome 
and complications following revision shoulder arthroplasty: a 
systematic review and meta-analysis. Bone Jt Open. 2021; 
2(8):618-30. doi:10.1302/2633-1462.28.Bjo-2021-0092.R1.
14. Manauté F, Lateur G, Gaillot J, Saragaglia D. Results of 
shoulder resurfacing arthroplasty at medium-term follow-up. 
Seminars in Arthroplasty: JSES; 2021:532-40.
15. Davidson PA, Rivenburgh D. Primary shoulder replacement 
using stemless inlay arthroplasty as a joint preservation 
alternative. Current Orthopaedic Practice. 2018; 29(3):237-
43. doi:10.1097/bco.0000000000000614.
16. Friedman RJ, Eichinger J, Schoch B, et al. Preoperative 
parameters that predict postoperative patient-reported 
outcome measures and range of motion with anatomic and 
reverse total shoulder arthroplasty. JSES Open Access. 2019; 
3(4):266-72. doi:10.1016/j.jses.2019.09.010.
17. O'Reilly SC, Muir KR, Doherty M. Effectiveness of home 
exercise on pain and disability from osteoarthritis of the 
knee: a randomized controlled trial. Ann Rheum Dis. 1999; 
58(1):15-9. doi:10.1136/ard.58.1.15.
18. Orfaly RM, Rockwood CA, Jr., Esenyel CZ, Wirth MA. A 
prospective functional outcome study of shoulder 
arthroplasty for osteoarthritis with an intact rotator cuff. J 
Shoulder Elbow Surg. 2003; 12(3):214-21. 
19. Gartsman GM, Roddey TS, Hammerman SM. Shoulder 
arthroplasty with or without resurfacing of the glenoid in 
patients who have osteoarthritis. J Bone Joint Surg Am. 2000; 
82(1):26-34. doi:10.2106/00004623-200001000-00004.
20. Padilla Colón CJ, Molina-Vicenty IL, Frontera-Rodríguez M, et 
al. Muscle and Bone Mass Loss in the Elderly Population: 
Advances in diagnosis and treatment. J Biomed (Syd). 2018; 
3:40-9. doi:10.7150/jbm.23390.
21. Garcia GH, Liu JN, Mahony GT, et al. Hemiarthroplasty versus 
total shoulder arthroplasty for shoulder osteoarthritis: A 
matched comparison of return to sports. Am J Sports Med. 
2016; 44(6):1417-22. doi:10.1177/0363546516632527.
22. Radnay CS, Setter KJ, Chambers L, Levine WN, Bigliani LU, 
Ahmad CS. Total shoulder replacement compared with 
humeral head replacement for the treatment of primary 
glenohumeral osteoarthritis: a systematic review. J Shoulder 
Elbow Surg. 2007; 16(4):396-402. 
23. Fossati C, Vitale M, Forin Valvecchi T, Gualtierotti R, Randelli 
PS. Management of Painful Shoulder Arthroplasty: A 
Narrative Review. Pain Ther. 2020; 9(2):427-39. 
24. Kopka M, Fourman M, Soni A, Cordle AC, Lin A. Can glenoid 
wear be accurately assessed using X-ray imaging? Evaluating 
agreement of x-ray and magnetic resonance imaging (MRI) 
Walch classification. J Shoulder Elbow Surg. 2017; 
26(9):1527-32. doi:10.1016/j.jse.2017.03.014.
25. Migliorini F, Vecchio G, Baroncini A, Pintore A, Oliva F, Maffulli 
N. Anatomic total shoulder arthroplasty versus 
hemiarthroplasty for glenohumeral osteoarthritis: a 
systematic review and meta-analysis. Applied Sciences. 2021; 
26. Levy O, Tsvieli O, Merchant J, et al. Surface replacement 
arthroplasty for glenohumeral arthropathy in patients aged 
younger than fifty years: results after a minimum ten-year 
follow-up. J Shoulder Elbow Surg. 2015; 24(7):1049-60. 
27. Eichinger JK, Rao MV, Lin JJ, et al. The effect of body mass 
index on internal rotation and function following anatomic 
and reverse total shoulder arthroplasty. J Shoulder Elbow 
Surg. 2021; 30(2):265-72. doi:10.1016/j.jse.2020.06.008.
28. Norris TR, Iannotti JP. Functional outcome after shoulder 
arthroplasty for primary osteoarthritis: a multicenter study. J 
Shoulder Elbow Surg. 2002; 11(2):130-5. 
29. Thangarajah T, Ajami S, Coathup M, et al. Revision shoulder 
arthroplasty for failed humeral head resurfacing 
hemiarthroplasty. Shoulder Elbow. 2019; 11(2 Suppl):35-41. 
30. Brewley EE, Jr., Christmas KN, Gorman RA, 2nd, Downes KL, 
Mighell MA, Frankle MA. Defining the younger patient: age as 
a predictive factor for outcomes in shoulder arthroplasty. J 
Shoulder Elbow Surg. 2020; 29(7s): S1-s8. 
31. Patel RB, Muh S, Okoroha KR, et al. Results of total shoulder 
arthroplasty in patients aged 55 years or younger versus 
those older than 55 years: an analysis of 1135 patients with 
over 2 years of follow-up. J Shoulder Elbow Surg. 2019; 
28(5):861-8. doi:10.1016/j.jse.2018.09.029.
32. Roberson TA, Bentley JC, Griscom JT, et al. Outcomes of total 
shoulder arthroplasty in patients younger than 65 years: a 
systematic review. J Shoulder Elbow Surg. 2017; 26(7):1298-
306. doi:10.1016/j.jse.2016.12.069.