Glenoid component preparation and soft tissue releases

Perhaps the most common reasons to perform a hemiarthroplasty instead of a TSA remain fear of glenoid component failure and difficulty exposing the glenoid. Numerous reports in the literature support the superiority of TSA to hemiarthroplasty for shoulder arthritis [4, 7, 13, 28]. Advocates of hemiarthroplasty use the argument than glenoid components fail; they are difficult to revise; and hemiarthroplasty can be later converted to TSA if necessary. Although some alarming papers on glenoid lucency have been reported, the rate of revision TSA secondary to glenoid failure remains low [6, 14, 29, 30]. It has been reported that primary TSA provides significantly better results than conversion of hemiarthroplasty to TSA [31]. Third, hemiarthroplasty can cause glenoid erosions that could potentially be difficult to handle during TSA. We firmly believe that glenoid replacement performed with meticulous attention to technique, including the approach, retractor placement, soft tissue balancing, and cement technique can lead to a successful and enduring solution for the arthritic shoulder.