Summary:Surgical reconstruction in shoulders with glenohumeral arthritis and rotator cufF deficiency is a challenging task. A number of alternatives, such as the use of constrained and unconstrained shoulder arthroplasty, have been advanced to treat this problem. In our experience, humeral hemiarthroplasty and total shoulder arthroplasty have yielded similar satisfactory results with respect to pain relief and function in patients with glenohumeral arthritis and cuff deficiency. However, better active elevation is often achieved with hemiarthroplasty, perhaps because there is less lateralization of the humerus, facilitating rotator cuff repair. Humeral hemiarthroplasty also avoids the risk of glenoid loosening, which may occur more frequently in rotator cuff-deficient shoulders, because of eccentric glenoid loading by the superiorly migrated humeral component. In cases in which the rotator cuff tear is easily reparable with tissue of satisfactory quality, total shoulder arthroplasty is a good option. However, when the cuff tear is larger and the tissue is atrophic and deficient, humeral hemiarthroplasty is preferred. The rotator cuff is repaired as well as possible, emphasizing anterior and posterior stability for the implant over complete superior coverage. This article reviews our operative technique and results with prosthetic replacement in the rotator cuffdeficient shoulder.