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: 2.29). 11/2012; 22(5). 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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Available from: Pierre Mansat, Jan 21, 2014
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    • "Follow-up, however, found progressive joint-line narrowing, with frequent recurrence of pain [5] [6]. A recent assessment of resurfacing in primary osteoarthritis of the shoulder reported well restored anatomy, increased lateral offset of the humeral head, a tendency towards varus implant positioning and a long-term trend towards glenoid wear [7]. In 2013, the Australian Orthopaedic Association Joint Registry likewise reported higher 5-year revision rates in shoulder resurfacing compared with anatomic stemmed implants [8]. "
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    ABSTRACT: Introduction Resurfacing shoulder arthroplasty is proposed in primary osteoarthritis of the shoulder. The present study compared resurfacing versus 3rd generation stemmed hemiarthroplasty in terms of survival, functional results and implant positioning effects. Materials and methods Seventy eight patients underwent arthroplasty for primary osteoarthritis of the shoulder: 41 by resurfacing and 37 by stemmed hemiarthroplasty. The two populations were comparable on all baseline variables. Minimum follow-up was 2 years. The principal assessment criterion was survivorship with surgical revision as end-point. Secondary criteria were functional results on Constant, quick-DASH, Neer and SSV scores, and implant positioning effects assessed on radiology. Results At a mean 44 months’ follow-up (range, 24–118 months), there were no significant differences in functional scores. Radiologic analysis found greater varus positioning and lateral offset of the humeral head in resurfacing compared with stemmed hemiarthroplasty (128° vs 138°, P < 0.01; 6.5 ± 2 vs 4.6 ± 1.6 mm, P < 0.01). Survivorship without revision was significantly poorer in resurfacing, with 4 revision procedures for glenoid wear (9.8%), versus none in hemiarthroplasty (P = 0.02). There was no correlation between humeral head size, positioning or lateral offset and revision. Conclusion Revision-free survival was significantly lower in resurfacing than in hemiarthroplasty. Greater humeral head size may increase lateral offset, accelerating glenoid wear. Down-sizing the humeral head in resurfacing procedures might limit these complications. Level of evidence Level III; case-control study.
    Full-text · Article · Oct 2014 · Orthopaedics & Traumatology Surgery & Research
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    • "Follow-up, however, found progressive joint-line narrowing, with frequent recurrence of pain [5] [6]. A recent assessment of resurfacing in primary osteoarthritis of the shoulder reported well restored anatomy, increased lateral offset of the humeral head, a tendency towards varus implant positioning and a long-term trend towards glenoid wear [7]. In 2013, the Australian Orthopaedic Association Joint Registry likewise reported higher 5-year revision rates in shoulder resurfacing compared with anatomic stemmed implants [8]. "

    Full-text · Dataset · Sep 2014
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    • "In the study by Mansat et al. (2013), the postoperative radiographs showed a decrease in humeral head diameter and in the height of the humeral head, without modification of the radius of curvature or the height of the center of rotation. The humeral offset was increased and the implants were mainly positioned in varus postoperatively. "
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    ABSTRACT: Background and purpose Humeral resurfacing has shown promising results for osteoarthritis, but revisions for glenoid erosion have been reported frequently. We investigated the hypothesis that preoperative glenoid wear and postoperative progress of glenoid erosion would influence the clinical outcome. Methods We reviewed 61 resurfacing hemiarthroplasties (55 patients) for primary osteoarthritis. 6 patients were lost to follow-up and 5 had undergone revision arthroplasty. This left 50 shoulders in 44 patients (mean age 66 years) that were followed for mean 30 (12–44) months. Complications, revisions, and the age- and sex-related Constant score were assessed. Radiographs were evaluated for loosening and glenoid erosion according to Walch. Results Of the 50 shoulders that were functionally assessed, the average age- and sex-related Constant score was 73%. In patients with preoperative type-B2 glenoids, at 49% it was lower than in type-A1 glenoids (81%, p = 0.03) and in type-B1 glenoids (84%, p = 0.02). The average age- and sex-related Constant score for patients with type-A2 glenoids (60%) was lower than for type-A1 and -B1 glenoids and higher than for type-B2 glenoids, but the differences were not statistically significant. In the total population of 61 shoulders, the radiographs showed postoperative glenoid erosion in 38 cases and no humeral prosthetic loosening. Revision arthroplasty was performed in 11 cases after 28 (7–69) months. The implant size had no statistically significant influence on the functional outcome. The size was considered to be adequate in 28 of the 50 functionally assessed shoulders. In 21 cases, the implant size was too large and in 1 case it was too small. Interpretation We found frequent postoperative glenoid erosion and a high rate of revision arthroplasty after humeral resurfacing for primary osteoarthritis. Oversizing of the implants was common, but it had no statistically significant influence on the functional outcome. Inferior results were found in the presence of increased eccentric preoperative glenoid wear. Total shoulder arthroplasty should be considered in these patients.
    Full-text · Article · Sep 2013 · Acta Orthopaedica
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