Surgery for Shoulder Osteoarthritis: A Cochrane Systematic Review

University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA.
The Journal of Rheumatology (Impact Factor: 3.17). 04/2011; 38(4):598-605. DOI: 10.3899/jrheum.101008
Source: PubMed

ABSTRACT To determine the benefits and harm of surgery for shoulder osteoarthritis (OA).
We performed a Cochrane Systematic Review of clinical trials of adults with shoulder OA, comparing surgical techniques [total shoulder arthroplasty (TSA), hemiarthroplasty, implant types, and fixation] to placebo, sham surgery, nonsurgical modalities, and no treatment. We also reviewed trials that compared various surgical techniques, reporting patient-reported outcomes (pain, function, quality of life, etc.) or revision rates. We calculated the risk ratio for categorical outcomes and mean differences for continuous outcomes with 95% CI.
There were no controlled trials of surgery versus placebo or nonsurgical interventions. Seven studies with 238 patients were included. Two studies compared TSA to hemiarthroplasty (n = 88). Significantly worse scores on the 0-100 American Shoulder and Elbow Surgeons scale (mean difference, -10.05 at 24-34 mo; 95% CI -18.97 to -1.13; p = 0.03) and a nonsignificant trend toward higher revision rate in hemiarthroplasty compared to TSA (relative risk 6.18; 95% CI 0.77 to 49.52; p = 0.09) were noted. With 1 study providing data (n = 41), no differences were noted between groups for pain scores (mean difference 7.8; 95% CI -5.33 to 20.93), quality of life on Medical Outcomes Study Short-Form 36 physical component summary (mean difference 0.80; 95% CI -6.63 to -8.23), and adverse events (relative risk 1.2; 95% CI 0.4 to 3.8).
TSA was associated with better shoulder function, with no other demonstrable clinical benefits compared to hemiarthroplasty. More studies are needed to compare clinical outcomes between them and comparing shoulder surgery to sham, placebo, and other nonsurgical treatment options.

1 Follower
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    • "Nonetheless, some patients fail to benefit from the operation, which may be due to glenoid wear (Parsons et al. 2004). Total shoulder arthroplasty (TSA) may be the preferred treatment due to a superior functional outcome, but the risk of glenoid loosening has been worrying (Bishop and Flatow 2005, Bryant et al. 2005, Radnay et al. 2007, Singh et al. 2011). The first resurfacing hemiarthroplasty (RHA) to be used in a greater numbers was the SCAN (Scandinavian) Cup, which was introduced in 1981 for the treatment of rheumatoid arthritis (Jonsson et al. 1986). "
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    ABSTRACT: Purpose We used patient-reported outcome and risk of revision to compare hemiarthroplasty (HA) with total shoulder arthroplasty (TSA) and stemmed hemiarthroplasty (SHA) with resurfacing hemiarthroplasty (RHA) in patients with glenohumeral osteoarthritis. Patients and methods We included all patients reported to the Danish Shoulder Arthroplasty Registry (DSR) between January 2006 and December 2010. 1,209 arthroplasties in 1,109 patients were eligible. Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome 1 year postoperatively. For simplicity of presentation, the raw scores were converted to a percentage of the maximum score. Revision rates were calculated by checking reported revisions to the DSR until December 2011. WOOS and risk of revision were adjusted for age, sex, previous surgery, and type of osteoarthritis. Results There were 113 TSAs and 1096 HAs (837 RHAs and 259 SHAs). Patients treated with TSA generally had a better WOOS, exceeding the predefined minimal clinically important difference, at 1 year (mean difference 10, p < 0.001). RHA had a better WOOS than SHA (mean difference 5, p = 0.02), but the difference did not exceed the minimal clinically important difference. There were no statistically significant differences in revision rate or in adjusted risk of revision between any of the groups. Interpretation Our results are in accordance with the results from other national shoulder registries and the results published in systematic reviews favoring TSA in the treatment of glenohumeral osteoarthritis. Nonetheless, this registry study had certain limitations and the results should be interpreted carefully.
    Acta Orthopaedica 04/2014; 85(2):117-22. DOI:10.3109/17453674.2014.893497 · 2.45 Impact Factor
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    ABSTRACT: Glenoid component malposition for anatomic shoulder replacement may result in complications. The purpose of this study was to define the efficacy of a new surgical method to place the glenoid component. Thirty-one patients were randomized for glenoid component placement with use of either novel three-dimensional computed tomographic scan planning software combined with patient-specific instrumentation (the glenoid positioning system group), or conventional computed tomographic scan, preoperative planning, and surgical technique, utilizing instruments provided by the implant manufacturer (the standard surgical group). The desired position of the component was determined preoperatively. Postoperatively, a computed tomographic scan was used to define and compare the actual implant location with the preoperative plan. In the standard surgical group, the average preoperative glenoid retroversion was -11.3° (range, -39° to 17°). In the glenoid positioning system group, the average glenoid retroversion was -14.8° (range, -27° to 7°). When the standard surgical group was compared with the glenoid positioning system group, patient-specific instrumentation technology significantly decreased (p < 0.05) the average deviation of implant position for inclination and medial-lateral offset. Overall, the average deviation in version was 6.9° in the standard surgical group and 4.3° in the glenoid positioning system group. The average deviation in inclination was 11.6° in the standard surgical group and 2.9° in the glenoid positioning system group. The greatest benefit of patient-specific instrumentation was observed in patients with retroversion in excess of 16°; the average deviation was 10° in the standard surgical group and 1.2° in the glenoid positioning system group (p < 0.001). Preoperative planning and patient-specific instrumentation use resulted in a significant improvement in the selection and use of the optimal type of implant and a significant reduction in the frequency of malpositioned glenoid implants. Novel three-dimensional preoperative planning, coupled with patient and implant-specific instrumentation, allows the surgeon to better define the preoperative pathology, select the optimal implant design and location, and then accurately execute the plan at the time of surgery. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 12/2012; 94(23):2167-75. DOI:10.2106/JBJS.K.01209 · 4.31 Impact Factor
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    ABSTRACT: Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement.
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