Shoulder Hemiarthroplasty Periprocedural Care

Updated: Dec 23, 2015
  • Author: Paul H Eichenseer; Chief Editor: Dinesh Patel, MD, FACS  more...
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Periprocedural Care

Patient Education and Consent

Patient education is a critical part of the preoperative evaluation, as well as of the postoperative rehabilitation period. A multidisciplinary approach involving the surgeon, primary care physician, physician extenders, nurses, physical therapists, and occupational therapists provides the patient with the resources necessary for optimal outcomes. Educating the patient about reasonable goals, expectations, and outcomes as well as potential complications ensures that the patient can make an informed decision and be sufficiently motivated. The physical therapist plays a critical role in educating the patient as to ongoing home exercises that will optimize and maintain the health of the shoulder replacement.

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Equipment

Various humeral components are available for hemiarthroplasty, depending on patient-specific anatomy, bone quality, and surgical indication, as follows:

  • Humeral resurfacing caps without a stem (see the first image below)
  • Fluted stem prostheses for cementing (see the second image below)
  • Press-fit cementless stemmed prostheses (see the third image below)
  • Long-stem prostheses for fracture or revision (see the fourth image below)
  • Cobalt chrome or titanium alloy components
Tornier Aequalis resurfacing cap. Tornier Aequalis resurfacing cap.
Tornier Aequalis cemented primary shoulder. Tornier Aequalis cemented primary shoulder.
Tornier Aequalis press-fit primary shoulder. Tornier Aequalis press-fit primary shoulder.
Tornier Aequalis fracture shoulder. Tornier Aequalis fracture shoulder.

Levy and Copeland reported excellent results using cementless resurfacing caps for osteoarthritis of the shoulder. [29] By avoiding the use of a stemmed component, complications involving periprosthetic fracture and humeral insertion were avoided.

Modular systems offer multiple component choices to match patient-specific inclination and retroversion to restore proper anatomy. Modular systems have also revolutionized the revision of hemiarthroplasty to reverse total shoulder arthroplasty. In a revision surgery using previously implanted modular components, the humeral head can be removed from the stem and replaced with a reverse total shoulder cup component. This change-out bypasses the necessity for removing the humeral stem during the revision.

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Patient Preparation

Anesthesia

Patients receive a preoperative interscalene before being taken back to the operating room to anesthetize the upper roots of the brachial plexus. This provides excellent pain control in the immediate postoperative period and permits minimization of general anesthetic during the procedure. The anesthesiologist administers general anesthesia with neuromuscular paralysis for the duration of the surgical procedure.

Positioning

The patient is placed in the modified beach-chair/semi-Fowler position with knees flexed. A McConnell headrest allows proper positioning with the patient toward the top portion of table and with the affected shoulder's arm hanging off the table edge nearest the primary surgeon. The entire arm should then be draped and prepped in meticulous sterile fashion. [30]

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Monitoring & Follow-up

After hemiarthroplasty, long-term monitoring is left to the discretion of the surgeon on the basis of the stability of results after the initial 6 months of rehabilitation. Annual examinations with plain films can be scheduled to determine potential implant loosening, progressive glenoid wear, and to clinically examine shoulder function. Any loss of function, interference with previously normal activities of daily living, or progressive shoulder pain should prompt a visit to the surgeon; these symptoms may be indicative of implant wear or failure.

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