Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger

Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Journal of Shoulder and Elbow Surgery (Impact Factor: 2.37). 11/2004; 13(6):604-13. DOI: 10.1016/S1058274604001296
Source: PubMed

ABSTRACT Seventy-eight Neer hemiarthroplasties and thirty-six Neer total shoulder arthroplasties were performed in patients aged 50 years or younger between January 1, 1976, and December 31, 1985. Sixty-two hemiarthroplasties and twenty-nine total shoulder arthroplasties with complete preoperative evaluation, operative records, and a minimum 15-year follow-up (mean, 16.8 years) or follow-up until revision were included in the clinical analysis. Sixteen patients died, and seven were lost to follow-up. All 114 shoulders were included in the survival analysis. There was significant long-term pain relief (P < .01) and improvement in active abduction (P < .01) and external rotation (P < .01) with both procedures. There was not a significant difference between total shoulder arthroplasty and hemiarthroplasty with regard to pain relief, abduction, or external rotation. Radiographs were available for 53 hemiarthroplasties and 25 total shoulder arthroplasties with a minimum 10-year follow-up. Humeral periprosthetic lucency was present more frequently after total shoulder arthroplasty (60%) compared with hemiarthroplasty (34%) (P = .0079). Glenoid erosion was present in 38 of 53 hemiarthroplasties (72%). Glenoid periprosthetic lucency was present in 19 of 25 total shoulder arthroplasties (76%). The results were graded by use of a modified Neer result rating system. Among the hemiarthroplasties, there were 6 excellent (10%), 19 satisfactory (30%), and 37 unsatisfactory results (60%). Among total shoulder arthroplasties, there were 6 excellent (21%), 9 satisfactory (31%), and 14 unsatisfactory results (48%). The estimated survival rate for hemiarthroplasty was 82% (95% CI, 74%-92%) at 10 years and 75% (95% CI, 64%-86%) at 20 years. The estimated survival rate for total shoulder arthroplasty was 97% (95% CI, 91%-100%) at 10 years and 84% (95% CI, 68%-98%) at 20 years. The data from this study indicate that there is marked long-term pain relief and improvement in motion with shoulder arthroplasty. However, there is a moderate rate of hemiarthroplasty revision for painful glenoid arthritis. Unsatisfactory result ratings were most commonly a result of motion restriction from soft-tissue abnormalities. Great care must be exercised, and alternative methods of treatment considered, before either hemiarthroplasty or total shoulder arthroplasty is offered to patients aged 50 years or younger.

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    • "Previous studies on TSR have reported 10-year survival rates of between 93% and 97% (Torchia et al. 1997, Sperling et al. 2004, 2007, Deshmukh et al. 2005), which is much better than the 78% for reversed TSR in our study. Only Neer prostheses were used in these studies, as opposed to the reversed TSRs in our study. "
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    ABSTRACT: Arthroplasty for the proximal humerus problems secondary to fractures is troublesome, because of necrosis of the tubercles and the resulting insufficiency of the rotator cuff. The aim of this study was to investigate whether better results can be achieved with the differential use of anatomic and reverse shoulder prostheses, in comparison to the preoperative status. Fifty-five patients with secondary fracture prostheses due to sequelae of fractures of the humeral head were followed. Anatomic prostheses were implanted in 36 cases (fracture sequelae types 1 and 2 according to Boileau), and reversed prostheses were implanted in 19 cases (fracture sequelae types 3 and 4). The mean scores of the patients improved from 19 to 68 points (anatomic prosthesis) for fracture sequelae types 1 and 2, and from 9 to 47.5 points (reverse prosthesis) for fracture sequelae types 3 and 4. The differential use of anatomic and reversed shoulder prostheses in secondary fracture treatment leads to an improvement in postoperative results. In fracture sequelae types 1 and 2, the anatomic prosthesis is a better choice. However, in fracture sequelae types 3 and 4 with severe deformities, the reversed prosthesis is clearly superior to the anatomic prosthesis.
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