Surface arthroplasty in shoulder arthritis

Avascular Necrosis of the Humeral Head: Hemi-Cap, Cap, or Stemmed Solution?

“…More recently, subtotal final techniques for localized resurfacing of the humeral articular surface without significant removal of bone stock has demonstrated significant advances in preservation of natural anatomy, allowing minimal bone removal while providing an environment, which allows simpler more straightforward revision to total shoulder arthroplasty should that at a later date be required. [3][4][5] Clearly, the degree of AVN should dictate the degree of prosthetic replacement. This article will focus on the indications for focal resurfacing ("hemi-cap"), management of en-tire humeral head involvement with total resurfacing or "cup arthroplasty" of the humeral head, conservative resurfacing of both articular surfaces of the humeral head and glenoid, and indications when formal total shoulder arthroplasty with a stemmed implant with or without total shoulder resurfacing is indicated.…”

“…6 This preserves humeral head and intramedullary canal integrity and allows relatively easy revision surgery. 5 The concept of a "hemi-cap" has only recently evolved. 1 This procedure replaces only the focally diseased articular surface, preserves the surrounding articular cartilage (assuming it is intact and healthy), restores the surface geometry that is being replaced, and allows easy revision should this be necessary at a later date.…”