Why the committee made the recommendation
Evidence showed that conventional total shoulder replacement provides more overall benefit than humeral hemiarthroplasty. The recommendation is limited to people with adequate glenoid bone because this is necessary for conventional total shoulder replacement to be considered. For people without adequate glenoid bone, another solution, such as reverse shoulder replacement or other surgery, is needed.
The committee agreed that the type of implant should not be specified in the recommendation but should be part of shared decision making between the person having surgery and the surgeon.
Conventional total shoulder replacement is increasingly being offered to people aged under 60 as confidence grows in its long-term durability. There is a lack of evidence in this age group, so the committee made a recommendation for research to compare conventional total shoulder replacement with humeral hemiarthroplasty.
The committee were unable to make a recommendation for practice on reverse total shoulder replacement in this context because of the lack of evidence and their uncertainty about its effectiveness compared with other procedures. The committee noted that although reverse total shoulder replacement was originally designed for people with a rotator cuff tear, it is being used more widely for people with no rotator cuff tear to obviate the need for early revision surgery after rotator cuff failure. The committee made a recommendation for research to compare reverse total shoulder replacement with conventional total shoulder replacement.