Exploring the role of hemiarthroplasty in revision shoulder arthroplasty: a systematic review

Background: Hemiarthroplasty (HA) is a salvage option in revision shoulder arthroplasty when reimplantation (aTSA/rTSA) or secure glenoid fixation is not feasible. This systematic review evaluates indications, clinical outcomes, and complications after conversion to HA using an indication- and implant-stratified synthesis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed/MEDLINE, Embase/Scopus, and Web of Science were queried to 15 March 2024. Studies reporting revision of any shoulder arthroplasty to HA with ≥ 12-month follow-up were included. Owing to heterogeneity in measures and implant types, a descriptive analysis stratified by initial implant × indication was performed; primary endpoints were postoperative functional scores, with complications and reoperations as secondary endpoints. Results: Of 580 identified studies, 20 met inclusion criteria, totaling 268 patients. Glenoid component loosening was the most frequent indication (≈59%), followed by soft-tissue insufficiency (≈11%) and infection (≈9%). Postoperative function varied: ASES 48.2-66, constant 22-37, SANE 54-70. Complications occurred in 29%, and 15.7% underwent reoperation. Outcomes were indication-dependent: the highest scores were observed after humeral loosening (small subgroup), whereas glenoid loosening after aTSA or rTSA showed moderate, clinically meaningful improvements, particularly when bone loss could be reconstructed (e.g., grafting). Instability yielded modest gains, and infection was associated with the poorest results. Preoperative values were inconsistently reported, limiting Δ estimates. Conclusions: HA remains a salvage solution with indication-dependent effectiveness: best after humeral/glenoid loosening when reconstruction is feasible, modest in instability, and poor in infection. While HA can relieve pain and provide moderate functional improvement, it does not restore normal function. Selection should be deliberate and indication-specific, and future studies should adopt standardized reporting and prospective, indication-stratified designs.