Shoulder Resurfacing
DESCRIPTION
Shoulder resurfacing is a surgical procedure that involves replacing the diseased part of the shoulder joint without replacing the humeral head. Resurfacing of the humeral head can be accomplished with a prosthetic metal covering or cap that provides either complete or partial coverage, or can be performed alone (hemi-resurfacing) or in combination with glenoid resurfacing (total shoulder resurfacing).
POLICY
Shoulder resurfacing, including total, hemi, or partial resurfacing, is considered investigational.
Policies with similar titles: Hip Resurfacing
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
SOURCES
Armitage, J. S., Faber, K. J., Drosdowech, D. S., Litchfield, R. B., & Athwal, G. S. (2010). Humeral head bone defects: Remplissage, allograft, and arthroplasty. Orthopedic Clinics of North America, 41, 417-425.
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2010). Shoulder Resurfacing (7.01.119). Retrieved July 29, 2011 from BlueWeb. (10 articles and/or guidelines reviewed)
Burgess, D. L., McGrath, M. S., Bonutti, P. M., Marker, D. R., Delanois, R. E., & Mont, M. A. (2009). Shoulder resurfacing. The Journal of Bone and Joint Surgery, 91 (5), 1228-1238.
Davidson, P. A. & Rivenburgh, D. (2008). Focal anatomic patellofemoral inlay resurfacing: Theoretic basis, surgical technique, and case reports. Orthopedic Clinics of North America, 39, 337-346.
Millett, P. J., Gobezie, R., & Boykin, R. E. (2008). Shoulder osteoarthritis: Diagnosis and management. American Family Physician, 78, (5) 605-611.
National Institute for Health and Clinical Excellence. (2010, July). Shoulder resurfacing arthroplasty. Retrieved July 28, 2011 from http://www.nice.org.uk/nicemedia/live/12335/49883/49883.pdf.
Reineck, J. R., Krishnan, S. G., & Burkhead, W. Z. (2008). Early glenohumeral arthritis in the competing athlete. Clinical Journal of Sport Medicine, 27, 803-819.
U. S. Food and Drug Administration. (2008, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K080990. Retrieved November 25, 2008 from http://www.accessdata.fda.gov/cdrh_docs/pdf8/K080990.pdf.
Wiater J. M., & Fabing, M. H. (2009). Shoulder arthroplasty: Prosthetic options and indications. The Journal of the American Academy of Orthopaedic Surgeons, 17 (7), 415-425.
ORIGINAL EFFECTIVE DATE: 12/12/2009
MOST RECENT REVIEW DATE: 10/13/2011
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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