Is There Still a Role for Shoulder Hemiarthroplasty in Patients with Primary Glenohumeral Osteoarthritis? A Meta-analysis.

Abstract

Shoulder osteoarthritis (OA) commonly affects aging populations and often requires surgery. Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are key options; TSA resurfaces both joint surfaces, while HA is preferred in select patients. The optimal approach remains unclear due to conflicting evidence. A search across PubMed, Scopus, Cochrane, and Google Scholar through August 2025 identified 17 comparative studies involving patients with primary shoulder OA. Outcomes included perioperative variables (operative time, blood loss, LOS), pain (VAS, Constant), functional scores (ASES, UCLA, Constant, SSV), shoulder ROM, complication and reoperation rates, and quality-of-life measures (satisfaction, return to work, implant survival). TSA showed significantly better pain relief, functional scores, and shoulder ROM. It also had lower rates of rotator cuff tears, component dislocations, glenoid complications, stiffness, residual pain, satisfaction, and both revision/non-revision reoperations (all <i>p</i> < 0.05). HA was superior in operative time (<i>p</i> = 0.03), blood loss (<i>p</i> < 0.001), and LOS (<i>p</i> = 0.05). No significant differences were found in systemic complications, periprosthetic infections and fractures, shoulder instability, return to work, or 10-year implant survival. TSA provides superior pain, function, and mobility outcomes and is preferred for patients with advanced OA. HA remains suitable for those with limited physiologic reserve, minimal glenoid wear, or lower functional demands. These results highlight the need for individualized procedure selection based on patient characteristics.