Long-Term Follow-up of Shoulder Hemiarthroplasty for Glenohumeral Osteoarthritis.
ABSTRACT There is major controversy surrounding the use of hemiarthroplasty as compared with total shoulder arthroplasty for glenohumeral osteoarthritis, and long-term clinical outcomes of hemiarthroplasty are lacking.
Of a cohort of thirty patients (thirty-one shoulders) who were treated with hemiarthroplasty for glenohumeral osteoarthritis and followed longitudinally at our institution, twenty-five were available for long-term follow-up; five died, and one refused to participate. Three of the five patients who died had revision arthroplasty before death, and the data from those three were therefore included in the final follow-up (final follow-up data therefore included twenty-seven patients and twenty-eight shoulders). Follow-up through phone conversations and postal mail surveys included the following: Short Form-36, American Shoulder and Elbow Surgeons (ASES) shoulder outcome score, EuroQol, Simple Shoulder Test, modified Neer Score, and a unique, validated self-administered range-of-motion questionnaire. Correlations between clinical outcome and age, type of glenoid wear, and cause of osteoarthritis were determined.
The average follow-up was 17.2 years (range, thirteen to twenty-one years). There were eight revisions (three of fifteen shoulders with concentric glenoids, and five of sixteen shoulders with eccentric glenoids). For those shoulders not revised, the average ASES score was 70.54 (range, 36.67 to 91.67). Overall, active shoulder forward elevation and external rotation with the arm at 90° of abduction increased from 104° preoperatively to 141.8° (range, 45° to 180°) and 20.7° to 61.0° (range, 30° to 90°), respectively (p < 0.05), at the time of final follow-up. Of those who required revision arthroplasty, the average patient age at the time of the index procedure was 51.0 years (range, twenty-six to eighty-one years), while those not requiring revision averaged 57.1 years (range, twenty-seven to sixty-three years). The overall Neer satisfaction rating was 25%. The average Neer score and Neer rating for unrevised cases were significantly higher for concentric glenoid wear compared with eccentric glenoid wear (p = 0.015 and p = 0.001, respectively). Patients who had concentric glenoid wear had higher EuroQol scores (p = 0.020). The average Neer scores were 65.29 (range, forty-seven to seventy-eight) for primary osteoarthritis and 54.46 (range, forty to seventy-seven) for secondary osteoarthritis (p = 0.036).
Only 25% of patients with glenohumeral osteoarthritis treated with shoulder hemiarthroplasty are satisfied with their outcome at an average of seventeen years after the operation. Patients with concentric glenoid wear and primary osteoarthritis have better outcomes than those with eccentric glenoid wear and secondary osteoarthritis do, but patients in both groups experienced deterioration of results over time.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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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.Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 12/2014; 24(2). DOI:10.1016/j.jse.2014.09.029 · 2.37 Impact Factor
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ABSTRACT: The aim of this study was to compare surgical treatment options for young patients with glenohumeral arthritis. A systematic review of the English-language literature was conducted by searching PubMed, EMBASE, and Scopus with the following term: "(shoulder OR glenohumeral) AND (arthritis OR osteoarthritis) AND (young OR younger)." Studies that reported clinical or radiological outcomes of nonbiologic surgical treatment of generalized glenohumeral arthritis in patients younger than 60 years of age were included. Data were extracted to include study and patient characteristics, surgical technique, outcome scores, pain relief, satisfaction, functional improvement, return to activity, health-related quality of life, complications, need for and time to revision, range of motion, and radiological outcomes. Study quality was assessed with the Modified Coleman Methodology Score. Thirty-two studies containing a total of 1,229 shoulders met the inclusion criteria and were included in the review. Pain scores improved significantly more after total shoulder arthroplasty (TSA) than after hemiarthroplasty (HA) (P < .001). Patient satisfaction was similar after HA and TSA. Revision surgery was equally likely after HA, TSA, and arthroscopic debridement (AD). Complications were significantly less common after AD than after HA (P = .0049) and TSA (P < .001). AD and TSA afforded better recovery of active forward flexion and external rotation than did HA. At radiological follow-up, subluxation was similarly common after HA and TSA. According to current Level IV data, TSA and HA provide greater improvement of pain and range of motion than does HA in the surgical treatment of young patients with glenohumeral arthritis. AD is an efficacious and particularly safe alternative in the short term for young patients with concerns about arthroplasty. Level IV, systematic review of Level IV studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.Arthroscopy The Journal of Arthroscopic and Related Surgery 12/2014; DOI:10.1016/j.arthro.2014.11.012 · 3.19 Impact Factor
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ABSTRACT: Background Little information is available on the long-term outcome of shoulder arthroplasty in young patients. The purpose of this study was to report the results, complications, and revision rate of total shoulder arthroplasties (TSAs) in patients younger than 50 years at a minimum 20-year follow-up. Materials and methods Between 1976 and 1985, a single surgeon performed 78 Neer hemiarthroplasties (HAs) and 36 Neer TSAs in patients < 50 years. Fifty-six HAs and 19 TSAs with a minimum 20-year follow-up, or follow-up until reoperation, were analyzed for clinical, radiographic and survivorship outcomes. Results Both HA and TSA showed significant improvements in pain scores (P < .001), abduction (P < .01), and external rotation (P = .02). Eighty-one percent of shoulders were rated much better or better than preoperatively. Modified Neer ratings were similar between groups (P = .41). Unsatisfactory ratings in HA were due to reoperations in 25 (glenoid arthrosis in 16) and limited motion, pain, or dissatisfaction in 11. Unsatisfactory ratings in TSA were due to reoperations in 6 (component loosening in 4) and limited motion in 5. Estimated 20-year survival was 75.6% (confidence interval, 65.9-86.5) for HAs and 83.2% (confidence interval, 70.5-97.8) for TSAs. Discussion At long-term follow-up, both HA and TSA continue to provide lasting pain relief and improved range of motion. However, there are a large number of unsatisfactory Neer ratings. Whereas both groups have survivorship in excess of 75% at 20 years, surgeons should remain cautious in performing shoulder arthroplasty in the young patient.