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.
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise its use will be considered investigational.
Policies with similar titles: Total Hip Resurfacing
ADDITIONAL INFORMATION
In the absence of any well-designed randomized controlled trials or studies, no conclusions can be determined concerning the effects of this technology on health outcomes.
SOURCES
Ålund, M., Hoe-Hansen, C., Tillander, B., Heden, B., & Norlin, R. (2000). Outcome after cup hemiarthroplasty in the rheumatoid shoulder. A retrospective evaluation of 39 patients followed for 2-6 years. Acta Orthopaedica Scandinavica, 71 (2), 180-184. (Level 3 Evidence - Independent study)
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2009). Shoulder resurfacing (7.01.119). Retrieved July 23, 2009 from BlueWeb. (10 articles and/or guidelines reviewed)
Buchner, M., Eschbach, N., & Loew, M. (2008). Comparison of the short-term functional results after surface replacement and total shoulder arthroplasty for osteoarthritis of the shoulder: A matched-pair analysis. Archives of Orthopaedic and Trauma Surgery, 128 (4), 347-354. Abstract retrieved June 8, 2009 from PubMed database.
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.
Levy, O., & Copeland, S. A. (2001). Cementless surface replacement arthroplasty of the shoulder. 5 to 10-year results with the Copeland mark-2 prosthesis. The Journal of Bone and Joint Surgery, 83 (2), 213-221. (Level 2 Evidence - Industry sponsored)
Millett, P. J., Gobezie, R., & Boykin, R. E. (2008). Shoulder osteoarthritis: Diagnosis and management. American Family Physician, 78, (5) 605-611.
Radnay, C. S., Setter, K. J., Chambers, L., Levine, W. N., Bigiliani, L. U., & Ahmad, C. S. (2007). Total shoulder replacement compared with humeral head replacement for the treatment of primary glenohumeral osteoarthritis: A systematic review. Journal of Shoulder and Elbow Surgery, 16 (4 ), 396-402. Abstract retrieved June 8, 2009 from PubMed database.
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.
U. S. Food and Drug Administration. (2006, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K061862. Retrieved November 25, 2008 from http://www.accessdata.fda.gov/cdrh_docs/pdf6/K061862.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: 12/12/2009
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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