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Abstract Perhaps the most common reasons to perform a hemiarthroplasty instead of a TSA remain fear of glenoid component failure and difficulty exposing the glenoid. However numerous reports in the literature support the superiority of TSA to hemiarthroplasty for shoulder arthritis. There are obviously some situations in which a glenoid component cannot be used such as when there is insufficient bone stock, the rotator cuff is irreparably tom or very thin, there is a high likelihood that the humeral head will ride high and, in that situation, we prefer not to use a glenoid component. Many authers demonstrated that the use of a glenoid component when the bone stock was poor resulted in a high rate of loosening. Advocates ofhemiarthroplasty 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. It has been reported that primary TSA provides significantly better results than conversion of hemiarthroplasty to TSA. Besides, 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. Fear of early glenoid loosening in the young patient IS a relative contraindication of glenoid resurfacing. For such patients who elect to undergo hemiarthroplasty, we consider the use of biological resurfacing of the glenoid. Early results with interpositional meniscal allograft have been encouraging. Humeral resurfacing arthroplasty is a viable treatment option for younger active patients. Early results indicate that the desired function and pain relief can be expected. Implant loosening and glenoid wear don’t appear to be of concerns in the short term despite the activity levels in many patiens.But it remains a procedure which restricted to a narrow range of patients with mild to moderate cases Successful arthroplasty of the glenohumeral joint in the arthritic patient depends on an understanding of the disease process and pattern of the disease. An assessment of the entire patient and strict criteria for the diagnosis of the glenohumeral joint as source ofthe patient’s symptoms is essential. The surgical technique necessitates meticulous care of the fragile soft and hard tissues with careful attention t~ soft tissue release, component orientation, and tissue balancing. If adhered to, the final result should be satisfying to both patient and the surgeon. |