Article

Resurfacing humeral prosthesis: do we really reconstruct the anatomy?

Orthopedic and Traumatology Department, Centre Hospitalier Universitaire de Toulouse Purpan, Toulouse, France. Electronic address: .
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] (Impact Factor: 2.37). 11/2012; DOI: 10.1016/j.jse.2012.07.014
Source: PubMed

ABSTRACT BACKGROUND: The goal of a resurfacing shoulder arthroplasty is to reproduce the individual's anatomy while preserving the bone stock of the humeral head. This study investigated the hypothesis that resurfacing the humeral prosthesis restores normal glenohumeral relationships and correlates with the final clinical results. MATERIALS AND METHODS: A resurfacing shoulder implant was performed in 61 patients (64 shoulders). Indications were primary osteoarthritis in 26, secondary osteoarthritis in 21, avascular necrosis in 4, rheumatoid arthritis in 4, dysplasia in 4, and for others indications in 5. RESULTS: At an average of 36 months (range, 24-65) of follow-up , the Constant score reached 68 points and the Quick-Disabilities of Arm, Shoulder and Hand score reached 28 points. Preoperative and postoperative radiographic analysis showed a decrease of the humeral head diameter (51 ± 5 vs 48 ± 5 mm) and of the height of the humeral head (21 ± 4 vs 19 ± 2 mm), without modification of the radius of curvature or the height of the center of rotation. The medial humeral offset increased from 3.3 ± 3.5 to 6.4 ± 3 mm and the lateral offset from 6.8 ± 9 to 10.4 ± 9 mm. The implant was mainly in varus postoperatively compared with preoperative values (122° ± 11° vs 134° ± 7°). Postoperative radiographic analysis and at the last follow-up did not show any significant difference, except for the increase of the depth of the glenoid from 4.2 ± 1.4 to 4.9 ± 1.8 mm. CONCLUSIONS: The resurfacing shoulder arthroplasty reproduces the normal anatomy and compensates glenohumeral wear. However, there was a tendency to position the prosthesis in varus because of technical imperfections. With follow-up, medialization of the humerus with glenoid wear was observed and was correlated in some patients with reappearance of pain.

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    ABSTRACT: Purpose The aim of this study was to conduct a randomised, clinical trial comparing stemmed hemiarthroplasty and resurfacing hemiarthroplasty in the treatment of glenohumeral osteoarthritis. Methods A total of 40 shoulders (35 patients) were randomised to stemmed hemiarthroplasty or resurfacing hemiarthroplasty and evaluated three and 12 months postoperatively using the Constant-Murley score (CMS) and Western Ontario Osteoarthritis of the Shoulder (WOOS) index. Results There were no statistically significant differences in age, gender or pre-operative scores except for WOOS at baseline. Two patients were lost to follow-up. Significant improvements in CMS and WOOS were observed at one year after both arthroplasty designs. At one year, the mean CMS was 48.9 (range 6-80) after resurfacing hemiarthroplasty and 59.1 (range 0-88) after stemmed hemiarthroplasty {mean difference 10.2 [95 % confidence interval (CI) −3.3 to 23.6], P = 0.14}. The mean WOOS was 59.2 (range 5.2-100.0) and 79.4 (range 12.8-98.6), respectively [mean difference 20.2 (95 % CI 3.4-36.9), P = 0.02]. No major complications occurred and there were no revisions. Conclusions The effects of resurfacing hemiarthroplasty tended to be inferior to those of stemmed hemiarthroplasty. It is unclear whether this reflects a real difference in effect or baseline differences due to the limited number of randomised patients. We suggest there is a need for a larger, more definitive trial.
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    ABSTRACT: Prosthetic shoulder arthroplasty provides excellent pain relief and functional restoration for patients with glenohumeral arthritis, but concerns of survivorship have limited its use in younger patients. Despite general reports of high long-term survivorship, implant failure and functional deterioration after total shoulder arthroplasty are major concerns in the management of younger patients. In addition to having a longer life expectancy, younger patients also tend to be more active and can be expected to place greater demands on their shoulder arthroplasty. Alternative strategies have been developed and used for shoulder arthroplasty in younger patients. This manuscript reviews current concepts of shoulder arthroplasty in young patients. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
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