Surgery Section - Shoulder Resurfacing

IMPORTANT REMINDER

Regence Medical Policies are developed to provide guidance for members and providers regarding coverage in accordance with contract terms. Benefit determinations are based in all cases on the applicable contract language. To the extent there may be any conflict between the Medical Policy and contract language, the contract language takes precedence.

PLEASE NOTE: Contracts exclude from coverage, among other things, services or procedures that are considered investigational or cosmetic. Providers may bill members for services or procedures that are considered investigational or cosmetic. Providers are encouraged to inform members before rendering such services that the members are likely to be financially responsible for the cost of these services.

DESCRIPTION

Shoulder joint resurfacing is a surgical alternative to shoulder arthroplasty for the treatment of glenohumeral arthropathy. In contrast to shoulder arthroplasty, resurfacing does not involve complete humeral head replacement. Instead, the diseased tissue is removed and the remainder of the humeral head is fitted with a metal-alloy cap. This approach preserves the humeral neck and a portion of the humeral head. Resurfacing of the humeral head can be accomplished with devices that provide either complete or partial coverage, and may be performed alone (hemi-resurfacing) or in combination with glenoid resurfacing (total shoulder resurfacing).

Several prosthetic devices for shoulder resurfacing have received 510(k) approval from the U.S. Food and Drug Administration (FDA).

POLICY/CRITERIA

Shoulder resurfacing, including total and hemi-resurfacing is considered investigational.

POSITION SUMMARY

The evidence is not sufficient to permit conclusions about the benefits of shoulder resurfacing in the treatment of glenohumeral arthropathy compared to shoulder arthroplasty, the current standard of care:

• There is no reliable, long-term evidence from well-designed, randomized controlled trials on the effectiveness of shoulder resurfacing in the treatment of glenohumeral arthropathy.
  
  
• It is uncertain whether shoulder resurfacing is as effective as shoulder arthroplasty. It is not known whether shoulder resurfacing leads to improved pain reduction and restoration of function compared to shoulder arthroplasty.
  
  
• The long-term stability and durability of the implant are not known.

Effectiveness

Randomized Controlled Trials

No randomized controlled trials evaluated the effectiveness of shoulder resurfacing compared to shoulder arthroplasty. One clinical trial is in progress, but there are no published data from this study yet. (9)

Non-randomized comparative studies and case series

Several case series and non-randomized comparative studies described the experiences of patients undergoing shoulder resurfacing. (2-8, 10) Overall, the findings suggest that resurfacing may be a viable alternative to arthroplasty. While these studies contribute to the body of knowledge on shoulder replacement by providing direction for future research, the evidence from these studies is unreliable due to inherent design flaws such as non-random allocation of treatment and a lack of appropriate comparison groups.

Safety

No major adverse events have been reported in the published literature. (2-7, 11) Loosening of the prosthesis and glenoidal erosion are the most frequently reported complications. One intraoperative periprosthetic fracture has been reported. (11) Finally, proximal migration of the cup and glenoid wear have been reported in patients with rheumatoid arthritis. (7, 11)

References

1. BlueCross BlueShield Association Medical Policy Reference Manual, Policy No. 7.01.119
2. Levy O, Copeland SA. Cementless surface replacement arthroplasty of the shoulder. 5- to 10-year results with the Copeland mark-2 prosthesis. J Bone Joint Surg Br 2001; 83(2):213-21
3. Levy O, Copeland SA. Cementless surface replacement arthroplasty (Copeland CSRA) for osteoarthritis of the shoulder. J Shoulder Elbow Surg 2004; 13(3):266-71
4. Levy O, Funk L, Sforza G et al. Copeland surface replacement arthroplasty of the shoulder in rheumatoid arthritis. J Bone Joint Surg Am 2004; 86-A(3):512-8
5. Thomas SR, Wilson AJ, Chambler A et al. Outcome of Copeland surface replacement shoulder arthroplasty. J Shoulder Elbow Surg 2005; 14(5):485-91
6. Buchner M, Eschbach N, Loew M. Comparison of the short-term functional results after surface replacement and total shoulder arthroplasty for osteoarthritis of the shoulder: a matched-pair analysis. Arch Orthop Trauma Surg 2008; 128(4):347-54
7. Fuerst M, Fink B, Rüther W. The DUROM cup humeral surface replacement in patients with rheumatoid arthritis. J Bone Joint Surg Am 2007; 89(8):1756-62
8. Uribe JW, Bemden AB. Partial humeral head resurfacing for osteonecrosis. J Shoulder Elbow Surg 2009 Jan 29 [Epub ahead of print]
9. ClinicalTrials.gov: A service of the U.S. National Institutes of Health. http://www.clinicaltrials.gov/ct2/results?term=shoulder+resurfacing  (Verified August 11, 2009)
10. Grondin P, Leith J. Case series: Combined large Hill-Sachs and bony Bankart lesions treated by Latarjet and partial humeral head resurfacing: a report of 2 cases. Can J Surg. 2009 Jun;52(3):249-54
11. Burgess DL, McGrath MS, Bonutti PM at al. Shoulder resurfacing. J Bone Joint Surg Am. 2009 May;91(5):1228-38

Cross References

None

Surgery Section Table of Contents