Surgery for Shoulder Osteoarthritis: A Cochrane Systematic Review

University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA.
The Journal of Rheumatology (Impact Factor: 3.19). 04/2011; 38(4):598-605. DOI: 10.3899/jrheum.101008
Source: PubMed


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.

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Available from: Jasvinder A Singh, Sep 20, 2015
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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.
    Full-text · Article · Apr 2014 · Acta Orthopaedica
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    • "Singh et al. 10 found worse function in partial arthroplasty, but found no difference regarding to pain and state that both types of substitution (partial and total) improved the quality of life of patients with OA. In our study it was not possible to correlate the results for each type of arthroplasty due to the small number of patients. "
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    ABSTRACT: To evaluate the correlation between radiographic parameters and functional assessments of patients with osteoarthritis of the shoulder who underwent shoulder arthroplasty and to describe the functional outcomes of this procedure in our institution. We evaluated 21 patients (22 shoulders) who underwent shoulder arthroplasty between 1998 and 2010 and with a minimum follow-up of 12 months. Clinical evaluation was performed using the Constant-Murley scale, UCLA, EVA and by measuring the active motion. We analysed preoperative (distance between the top of the head and the humerus and the acromion, superior migration, neck angulation, medial "offset", subluxation, glenoid erosion) and postoperative radiographic parameters (rod inclination, migration of components and loosening). PATIENTS SHOWED SIGNIFICANT IMPROVEMENT IN ALL PARAMETERS: flexion (p = 0.0083), abduction (p = 0.0266), external rotation (p = 0.0062), Constant-Murley (p = 0.0001 ), UCLA (p <0.0001) and VAS (p = 0.0002). The superior migration of the humerus showed a significant correlation with UCLA and Constant-Murley scores (p = 0.0480 and p = 0.0110, respectively). The other radiographic parameters showed no correlation with the clinical outcomes. The superior migration of the humerus is related to worse clinical scores. Level of Evidence IV, Case Series.
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