Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 10, pp 3203–3211 | Cite as

Humeral head resurfacing is associated with less pain and clinically equivalent functional outcomes compared with stemmed hemiarthroplasty at mid-term follow-up

  • Mitchell S. Fourman
  • Andrea Beck
  • Gregory Gasbarro
  • James J. Irrgang
  • Mark W. Rodosky
  • Albert LinEmail author



Humeral head resurfacing (HHR) is a less invasive, anatomic alternative to the conventional stemmed hemiarthroplasty in patients in whom isolated humeral head replacement is preferred. It was hypothesized that, in a mid-term cross-sectional subjective outcome analysis, HHR would have equivalent patient-reported and functional outcomes to stemmed hemiarthroplasty (HA).


A total of 213 HHR and 153 HA procedures were performed at a single academic institution from 2000 to 2014. Of these, 106 HHR and 47 HA patients corresponding with 120 HHR and 55 HA shoulders responded to a survey that collected patient demographics, surgical outcomes, patient satisfaction, and self-reported range of motion scores using both bespoke and validated metrics.


Follow-up was longer in the HA group (9.4 ± 3.4 vs. 5.2 ± 1.8 years, p < 0.0001). Self-reported range of motion was equivalent between groups. Surgery was perceived as helpful following 76.7% of HHRs and 78.2% of HAs (p > 0.99). The ASES pain subscore was significantly worse in the HA group (25.2 ± 29.5 vs. 38.5 ± 12.7 after HHR, p < 0.0001), which translated into worse ASES total scores (45.1 ± 14.8 HA vs. 52.2 ± 23.7 HHR, p < 0.05). These findings were equivocal in responses received 2–8 years vs. ≥ 8 years after surgery.


Indications should be equivocal; humeral head resurfacing is a viable alternative to hemiarthroplasty, with equivalent patient satisfaction and reduced pain in the mid-term post-operative period.

Level of evidence



Humeral head resurfacing Hemiarthroplasty Shoulder osteoarthritis Patient-reported outcomes Rotator cuff dysfunction Shoulder arthroplasty Mid-term follow-up 



This study was awarded an Albert Ferguson Research Grant, internal funding assigned by the Department of Orthopaedic Surgery at the University of Pittsburgh Medical Center.

Compliance with ethical standards

Conflict of interest

Albert Lin is a consultant for Tornier and Arthrex for work unrelated to this study.

IRB approval

University of Pittsburgh, IRB# PRO14090251 and PRO14110352.


  1. 1.
    Alizadehkhaiyat O, Kyriakos A, Singer MS, Frostick SP (2013) Outcome of Copeland shoulder resurfacing arthroplasty with a 4-year mean follow-up. J Shoulder Elbow Surg 22:1352–1358CrossRefPubMedGoogle Scholar
  2. 2.
    Bjørnholdt KT, Brandsborg B, Søballe K, Nikolajsen L (2015) Persistent pain is common 1–2 years after shoulder replacement: a nationwide registry-based questionnaire study of 538 patients. Acta Orthop 86:71–77CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Brophy RH, Beauvais RL, Jones EC, Cordasco FA, Marx RG (2005) Measurement of shoulder activity level. Clin Orthop Relat Res 439:101–108CrossRefPubMedGoogle Scholar
  4. 4.
    Burgess DL, McGrath MS, Bonutti PM, Marker DR, Delanois RE, Mont MA (2009) Shoulder resurfacing. J Bone Joint Surg Am 91:1228–1238CrossRefPubMedGoogle Scholar
  5. 5.
    Busija L, Pausenberger E, Haines TP, Haymes S, Buchbinder R, Osborne RH (2011) Adult measures of general health and health-related quality of life: medical outcomes study short form 36-item (SF-36) and short form 12-item (SF-12) health surveys, Nottingham Health profile (NHP), sickness impact profile (SIP), medical outcomes study short form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care Res (Hoboken) 63(11):S383–S412CrossRefGoogle Scholar
  6. 6.
    Copeland S (2006) The continuing development of shoulder replacement: “reaching the surface”. J Bone Joint Surg Am 88:900–905PubMedGoogle Scholar
  7. 7.
    Delaney RA, Freehill MT, Higgins LD, Warner JJ (2014) Durability of partial humeral head resurfacing. J Shoulder Elbow Surg 23:e14–e22CrossRefPubMedGoogle Scholar
  8. 8.
    Duan X, Zhang W, Dong X, Liu M, Gao Y, Huang F et al (2013) Total shoulder arthroplasty versus hemiarthroplasty in patients with shoulder osteoarthritis: a meta-analysis of randomized controlled trials. Semin Arthritis Rheum 43:297–302CrossRefPubMedGoogle Scholar
  9. 9.
    Eichinger JK, Miller LR, Hartshorn T, Li X, Warner JJ, Higgins LD (2016) Evaluation of satisfaction and durability after hemiarthroplasty and total shoulder arthroplasty in a cohort of patients aged 50 years or younger: an analysis of discordance of patient satisfaction and implant survival. J Shoulder Elbow Surg 25:772–780CrossRefPubMedGoogle Scholar
  10. 10.
    Garcia GH, Liu JN, Mahony GT, Sinatro A, Wu HH, Craig EV et al (2016) Hemiarthroplasty versus total shoulder arthroplasty for shoulder osteoarthritis: a matched comparison of return to sports. Am J Sports Med 44:1417–1422CrossRefPubMedGoogle Scholar
  11. 11.
    Gartsman GM, Roddey TS, Hammerman SM (2000) Shoulder arthroplasty with or without resurfacing of the glenoid in patients who have osteoarthritis. J Bone Joint Surg Am 82:26–34CrossRefPubMedGoogle Scholar
  12. 12.
    Golant A, Christoforou D, Zuckerman JD, Kwon YW (2012) Return to sports after shoulder arthroplasty: a survey of surgeons’ preferences. J Shoulder Elbow Surg 21:554–560CrossRefPubMedGoogle Scholar
  13. 13.
    Iagulli ND, Field LD, Hobgood ER, Hurt JA, Charles R, O’Brien MJ et al (2014) Surface replacement arthroplasty of the humeral head in young, active patients: midterm results. Orthop J Sports Med 2:2325967113519407CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Jensen KL (2007) Humeral resurfacing arthroplasty: rationale, indications, technique, and results. Am J Orthop (Belle Mead NJ) 36:4–8Google Scholar
  15. 15.
    Johnson CC, Johnson DJ, Liu JN, Dines JS, Dines DM, Gulotta LV et al (2016) Return to sports after shoulder arthroplasty. World J Orthop 7:519–526CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kerr R, Resnick D, Pineda C, Haghighi P (1985) Osteoarthritis of the glenohumeral joint: a radiologic-pathologic study. Am J Roentgenol 144:967–972CrossRefGoogle Scholar
  17. 17.
    Levine WN, Djurasovic M, Glasson JM, Pollock RG, Flatow EL, Bigliani LU (1997) Hemiarthroplasty for glenohumeral osteoarthritis: results correlated to degree of glenoid wear. J Shoulder Elbow Surg 6:449–454CrossRefPubMedGoogle Scholar
  18. 18.
    Levine WN, Fischer CR, Nguyen D, Flatow EL, Ahmad CS, Bigliani LU (2012) Long-term follow-up of shoulder hemiarthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am 94:e164CrossRefPubMedGoogle Scholar
  19. 19.
    Levy O, Copeland SA (2001) Cementless surface replacement arthroplasty of the shoulder. 5- to 10-year results with the Copeland mark-2 prosthesis. J Bone Joint Surg Br 83:213–221CrossRefPubMedGoogle Scholar
  20. 20.
    Levy O, Tsvieli O, Merchant J, Young L, Trimarchi A, Dattani R et al (2015) 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 24:1049–1060CrossRefPubMedGoogle Scholar
  21. 21.
    Macdermid JC, Khadilkar L, Birmingham TB, Athwal GS (2015) Validity of the QuickDASH in patients with shoulder-related disorders undergoing surgery. J Orthop Sports Phys Ther 45:25–36CrossRefPubMedGoogle Scholar
  22. 22.
    Maltenfort M, Diaz-Ledezma C (2017) Statistics in brief: minimum clinically important difference-availability of reliable estimates. Clin Orthop Relat Res 475:933–946CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Mansat P, Coutie AS, Bonnevialle N, Rongieres M, Mansat M, Bonnevialle P (2013) Resurfacing humeral prosthesis: do we really reconstruct the anatomy? J Shoulder Elbow Surg 22:612–619CrossRefPubMedGoogle Scholar
  24. 24.
    Mechlenburg I, Amstrup A, Klebe T, Jacobsen SS, Teichert G, Stilling M (2013) The Copeland resurfacing humeral head implant does not restore humeral head anatomy. A retrospective study. Arch Orthop Trauma Surg 133:615–619CrossRefPubMedGoogle Scholar
  25. 25.
    Rasmussen JV, Olsen BS, Al-Hamdani A, Brorson S (2016) Outcome of revision shoulder arthroplasty after resurfacing hemiarthroplasty in patients with glenohumeral osteoarthritis. J Bone Joint Surg Am 98:1631–1637CrossRefPubMedGoogle Scholar
  26. 26.
    Saltzman BM, Leroux TS, Verma NN, Romeo AA (2018) Glenohumeral osteoarthritis in the young patient. J Am Acad Orthop Surg 26:e361–e370CrossRefPubMedGoogle Scholar
  27. 27.
    Sowa B, Thierjung H, Bulhoff M, Loew M, Zeifang F, Bruckner T et al (2017) Functional results of hemi- and total shoulder arthroplasty according to diagnosis and patient age at surgery. Acta Orthop 88:310–314CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Streubel PN, Simone JP, Cofield RH, Sperling JW (2016) Revision of failed humeral head resurfacing arthroplasty. Int J Shoulder Surg 10:21–27CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Sweet SJ, Takara T, Ho L, Tibone JE (2015) Primary partial humeral head resurfacing: outcomes with the HemiCAP implant. Am J Sports Med 43:579–587CrossRefPubMedGoogle Scholar
  30. 30.
    Tashjian RZ, Hung M, Keener JD, Bowen RC, McAllister J, Chen W et al (2017) Determining the minimal clinically important difference for the American Shoulder and Elbow Surgeons score, simple shoulder test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty. J Shoulder Elbow Surg 26:144–148CrossRefPubMedGoogle Scholar
  31. 31.
    Werner BC, Chang B, Nguyen JT, Dines DM, Gulotta LV (2016) What change in American Shoulder and Elbow Surgeons Score represents a clinically important change after shoulder arthroplasty? Clin Orthop Relat Res 474:2672–2681CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Widnall JC, Dheerendra SK, Macfarlane RJ, Waseem M (2013) The use of shoulder hemiarthroplasty and humeral head resurfacing: a review of current concepts. Open Orthop J 7:334–337CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Mitchell S. Fourman
    • 1
  • Andrea Beck
    • 2
  • Gregory Gasbarro
    • 2
  • James J. Irrgang
    • 3
  • Mark W. Rodosky
    • 2
  • Albert Lin
    • 2
    • 4
    Email author
  1. 1.School of MedicineUniversity of PittsburghPittsburghUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Department of Orthopaedic Surgery and Department of Physical TherapyUniversity of Pittsburgh Medical CenterPittsburghUSA
  4. 4.Division of Shoulder Surgery and Sports MedicineUPMC Center for Sports Medicine, University of PittsburghPittsburghUSA

Personalised recommendations