Summary

A systematic review comprehending over 7000 shoulders was performed in order to review the indications, treatment options, benefits, complications and outcomes of HHR

Abstract

Introduction

Humeral head resurfacing (HHR) is a technique that allows for preservation of the humeral bone and avoidance of a stemmed prosthesis in different shoulder pathologies. While total shoulder arthroplasties are still the most widely adopted option, more studies have been investigating the indications and potential benefits of the less invasive resurfacing technique. As such, the goal of this study is to review the indication, treatment options, benefits, complication, and outcomes of HHR.

Methods

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed on three online databases – PubMed, OVID MEDLINE, and OVID Embase – between their start and January 21st, 2022. The keywords used in the search were (HemiCAP OR Shoulder resurfacing) AND (Shoulder OR Humeral head OR Arthroplasty). The variables of interest extracted from the accepted studies included demographic data, indication for surgery, outcome, and complications. Critical appraisal of studies was conducted using the Methodological Index for Non-Randomized Studies (MINORS) tool.

Results

A total of 75 studies were accepted in the review, with a total of 9107 shoulders (3969 males, 4562 females, 576 unspecified). The mean age is 61.23 (±12.38) years old, and the mean follow-up time is 55.27 (±46.03) months. The main indication for surgery is osteoarthritis, rheumatoid arthritis, rotator cuff arthropathy and avascular necrosis. An in-depth analysis of the outcomes of HHR was performed as per major indication. Regarding level of evidence, only one paper was stated to be level I and two papers were level II. Seven papers have stated that they had no complications, revisions, or re-operations. There were at least 12 identified types of HHR implants used.

Conclusion

An evaluation of HHR and its outcomes according to each major indication was performed. In order to improve upon our knowledge regarding HHR and its outcomes, future research needs to focus on the following: conducting more high level-of-evidence studies that utilize randomization; more studies with participants that have received HHR for the same indication in order to have a homogenous mix of participants; more longitudinal and comparative studies that enable us to learn more about whether or not pyro-carbon can be used in HHR implants; more longitudinal studies in order to evaluate the long-term effects of HHR; and so on.