Shoulder Hemiarthroplasty in San Antonio, TX

What Is Shoulder Hemiarthroplasty?

Hemiarthroplasty replaces only the humeral head — the ball — without replacing the glenoid socket. It is a half-replacement, and the decision to use it rather than a total or reverse replacement depends on specific anatomic and clinical factors that vary by patient.

The most common indication I encounter is a complex proximal humerus fracture — specifically a four-part fracture or fracture-dislocation in an older patient where the blood supply to the humeral head has been disrupted and the bone cannot be reconstructed with plates and screws. In younger patients with the right anatomy, hemiarthroplasty may also be considered for avascular necrosis of the humeral head where the glenoid cartilage is still intact.

When Hemiarthroplasty Is the Right Choice

The primary competition for hemiarthroplasty in the fracture setting is reverse total shoulder replacement, which has become the more common choice for older patients because it is less dependent on tuberosity healing — the variable that most determines outcomes after hemiarthroplasty. I discuss both options with fracture patients in detail, explaining the tradeoffs between bone preservation and predictability of outcome.

For arthritic indications, hemiarthroplasty is appropriate when the glenoid cartilage is well-preserved but the humeral head is destroyed — a situation that is less common than symmetric joint space loss but does occur, particularly in avascular necrosis.

My Approach

For fracture hemiarthroplasty, meticulous tuberosity repair is the technical determinant of outcome. The greater tuberosity must heal in an anatomic position for the rotator cuff to function after surgery. I use a combination of suture techniques and, when appropriate, augmentation with bone graft to maximize tuberosity healing. My postoperative protocol protects tuberosity repair while beginning early passive motion to prevent stiffness.

I am selective about when hemiarthroplasty is the right tool. In elderly patients with low functional demands after complex fracture, reverse replacement often provides more predictable results with less dependence on tuberosity biology. Honest patient selection is more important than preference for any single implant type.

Recovery

Recovery after fracture hemiarthroplasty is protracted compared to elective arthroplasty because the tuberosities must heal before active use of the rotator cuff is permitted. Expect a sling for 4 to 6 weeks followed by a graduated active motion and strengthening program. Full functional recovery often takes 6 to 12 months. I set these expectations clearly before surgery so patients and families understand the commitment involved.

Quick Links

• Shoulder Anatomy
• Arthritis of the Shoulder
• Rotator Cuff Tear
• Shoulder Dislocation
• Frozen Shoulder
• Shoulder Instability
• Shoulder Fracture
• Biceps Tendon Rupture
• Shoulder Arthroscopy
• Total Shoulder Replacement
• Reverse Shoulder Replacement
• Shoulder Hemiarthroplasty
• Rotator Cuff Repair
• Shoulder Stabilization