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What results should I expect from joint resurfacing for shoulder arthritis?

Q: I'm thinking about having a procedure done for my shoulder arthritis called joint resurfacing. The surgeon tells me this has been around a good 30 years so it's not new. If that's true, what kind of results are people getting who have this operation done? Does it hold up? Would I end up with a shoulder replacement anyway and should just start there in the first place?

A: Joint resurfacing has been around since the early 1980s. That gives us 30-years of data to examine in order to see how well this technique is working. And in a recent study from England one surgeon reviews studies published on this topic and present the results of his 340 patients who had this procedure done.

The patients in the study ranged in ages from 37 to 89 years old but the average age was 70 years old. The underlying diagnosis was rheumatoid arthritis or osteoarthritis. Follow-up was possible for at least four years and some patients were in the study for as long as 16 years.

They found that the patients who had the best results had an intact rotator cuff and a diagnosis of osteoarthritis. Overall patient satisfaction was high with 94 per cent of the patients saying their shoulders were "better" or "much better" than before resurfacing.

The results were compared with a group of patients who had a total shoulder replacement. The surgeon reported equally good results between the two groups with far fewer complications in the joint resurfacing patients. Total shoulder replacement has a greater risk and incidence of infection and bone fractures.

The surgeon suggested that his method of balancing the soft-tissue around the shoulder prevents erosion of the shoulder socket (glenoid fossa). By releasing some of the soft tissues, the humeral head can be realigned to fit in the center of the socket where it functions best. Glenoid erosion is more likely when there is a soft tissue imbalance remaining after joint resurfacing.

The author concluded that using a cementless resurfacing prosthesis for advanced arthritis of the shoulder yields very satisfactory results. There are fewer complications than with a total joint replacement. And the basic bone stock has been saved if it becomes necessary to fuse the joint or replace it with a full implant later. High rates of patient satisfaction with the joint resurfacing procedure are an added bonus all around.

Reference: Ofer Levy, MD, MCh(Orth), FRCS. Shoulder Resurfacing: Is It Really As Good As Total Shoulder Replacement? In Current Orthopaedic Practice. January/February 2012. Vol. 23. No. 1. Pp. 2-9.