Massive and irreparable loss of rotator cuff tendon integrity can be a
ssociated with the development of glenohumeral and acromiohumeral arth
ritis.Loss of glenohumeral instability provided by the rotator cuff ma
y initiate and perpetuate this unique condition of the shoulder. Proxi
mal humeral replacement arthroplasty is the preferred surgical treatme
nt; special techniques of this procedure are presented. Patients are g
ratified by the durable restoration of comfort and, to a lesser extent
, function.