Total shoulder replacement compared with humeral head replacement for the treatment of primary glenohumeral osteoarthritis: A systematic review

ArticleinJournal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 16(4):396-402 · July 2007with25 Reads
DOI: 10.1016/j.jse.2006.10.017 · Source: PubMed
The optimal choice for the treatment of end-stage primary glenohumeral osteoarthritis remains controversial, with alternatives including total shoulder replacement (TSR) and humeral head replacement (HHR). The objective of this review was to analyze the effect of TSR compared with HHR on rates of pain relief, range of motion, patient satisfaction, and revision surgery in patients with primary glenohumeral osteoarthritis. We searched computerized databases for clinical studies published between 1966 and 2004 that reported on shoulder replacement for primary glenohumeral osteoarthritis. Pain data were converted to a 100-point score. Outcome assessment data were pooled when possible, and analyses via normal test statistics were performed. We identified 23 studies, with a total of 1952 patients and mean follow-up of 43.4 months (range, 30-116.4 months). The mean level of evidence was 3.73. Among the 23 studies, 7 different outcome instruments were used. Of the 23 studies, 14 (n = 1185) reported pain relief, 15 (n = 1080) reported range of motion, 12 (n = 969) reported patient satisfaction, and 14 (n = 1474) reported revision surgery. Compared with HHR, TSR provided significantly greater pain relief (P < .0001), forward elevation (P < .0001), gain in forward elevation (P < .0001), gain in external rotation (P = .0002), and patient satisfaction (P < .0001). Furthermore, only 6.5% of all TSRs required revision surgery, which was significantly lower than the percentage for all patients undergoing HHR (10.2%) (P < .025). Only 1.7% of all-polyethylene glenoid components required revision. On the basis of this review and analysis, in comparison with HHR, TSR for the treatment of primary glenohumeral osteoarthritis significantly improves pain relief, range of motion, and satisfaction and has a significantly lower rate of revision surgery. Inconsistent outcome reporting and poor study design may warrant standardization of outcome instruments and improved study design in the future.
    • "7:14am]1234567 // (SEL) [PREPRINTER stage] of 40 to 75 following the procedure and were satisfied with their outcome at final follow-up. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Cementless surface replacement hemiarthroplasty (CSRHA) is an established treatment for glenohumeral osteoarthritis; however, studies evaluating its role in arthritis with rotator cuff deficiency are limited. This study reviews the outcomes of CSRHA for glenohumeral osteoarthritis with and without rotator cuff tears. Methods: 41 CSRHA (Mark III Copeland prosthesis) were performed for glenohumeral osteoarthritis with intact rotator cuffs (n ¼ 21) and cuff-deficient shoulders (n ¼ 20). Patients were assessed using Oxford and Constant questionnaires , patient satisfaction, range of motion measurements and by radiography. Results: Mean age and follow-up were 75 years and 5.1 years, respectively. Functional gains were significantly higher in patients with intact rotator cuffs compared to cuff-deficient shoulders, with Oxford Shoulder Score improving from 18 to 37.5 and 15 to 27 and forward flexion improved from 60 to 126 and 44 to 77 in each group, respectively. Two patients with deficient cuffs had deficient subscapularis tendons; one of which was dislocated anteriorly. Conclusions: CSRHA provides significant improvements in pain and function in patients with glenohumeral osteoarth-ritis. In patients with deficient cuffs, functional gains are limited, and should be considered in low-demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis as a result of the risk of dislocation.
    Full-text · Article · Mar 2015
    • "In osteoarthritis patients, there was a higher risk with hemiprostheses than with total prostheses . This result is in accordance with other studies indicating a superior outcome with a total prosthesis compared to a hemiprosthesis (Bryant et al. 2005, Radnay et al. 2007, Singh et al. 2010, Fevang et al. 2013). As in all registry studies, a limitation exists in the completeness and reliability of registry data such as prosthesis type and supplementary surgery, and this problem is not easy to quantify. "
    [Show abstract] [Hide abstract] ABSTRACT: Background and purpose — Persistent postsurgical pain is a well-recognized problem after various types of surgery such as amputation and thoracotomy. The prevalence of persistent pain, and the extent to which it involves neuropathic pain, is highly dependent on the type of surgery. We investigated the prevalence of, characteristics of, and risk factors for persistent pain 1–2 years after shoulder replacement. Patients and methods — A questionnaire was sent to patients who underwent primary shoulder replacement between April 2011 and April 2012, and whose data were recorded in the Danish Shoulder Arthroplasty Register. Patients who had undergone reoperation or bilateral replacements were excluded. Persistent pain was defined as constant or daily pain within the last month, which interfered much or very much with daily activities. Multivariate logistic regression was used to assess risk factors. Results — 538 patients were available for analysis. The prevalence of persistent pain was 22% (CI: 18–25), and the prevalence of presumed neuropathic pain was 13% (CI: 10–16). Persistent pain was more frequent in fracture patients (29%) than in osteoarthritis patients (16%), while the prevalence of neuropathic pain was similar. Severe pain during the first postoperative week increased the risk of persistent pain. Risk also increased with hemiprosthesis (as compared to total prosthesis) in osteoarthritis patients, and with previous osteosynthesis and pain elsewhere in fracture patients. Interpretation — Persistent pain after shoulder replacement is a daily burden for many patients. Further studies should address patient and prosthesis selection, postoperative pain management, and follow-up of these patients.
    Full-text · Article · Nov 2014 · Acta Orthopaedica
    • "In a previous study from the Norwegian Arthroplasty Register (NAR), we reported superior results in terms of prosthesis survival with shoulder hemiprostheses (HPs) than with total prostheses (TPs), both anatomic and reverse (Fevang et al. 2009 ). However, several other studies have shown better functional results with the use of TPs than with HPs (Bryant et al. 2005, Pfahler et al. 2006, Radnay et al. 2007), and in a recent report from the NAR in which functional outcome was evaluated , patients with HPs came out worst for all variables measured (Fevang et al. 2013 ). Based on these studies and treatment practice in other countries, a change in treatment policy has taken place in Norway—towards reduced use of HPs and increasing use of TPs, both anatomic and reversed types. "
    [Show abstract] [Hide abstract] ABSTRACT: Background and purpose — Previously, implant survival of total shoulder prostheses was reported to be inferior to that of hemiprostheses. However, the use of total prostheses has increased in Norway due to reported good functional results. On this background, we wanted to study implant survival of 4 major shoulder prosthesis types in Norway between 1994 and 2012. Patients and methods — The study population comprised 4,173 patients with shoulder replacements reported to the Norwegian Arthroplasty Register, including 2,447 hemiprostheses (HPs), 444 anatomic total prostheses (ATPs), 454 resurfacing prostheses (RPs), and 828 reversed total prostheses (RTPs). Three time periods were compared: 1994–1999, 2000–2005, and 2006–2012. Kaplan-Meier failure curves were used to compare implant failure rates for subgroups of patients, and adjusted risks of revision were calculated using Cox regression analysis. Results — For prostheses inserted from 2006 through 2012, the 5-year survival rates were 95% for HPs (as opposed to 94% in 1994–1999), 95% for ATPs (75% in 1994–1999), 87% for RPs (96% in 1994–1999), and 93% for RTPs (91% in 1994–1999). During the study period, the implant survival improved significantly for ATPs (p < 0.001). A tendency of better results with acute fracture and worse results in sequelae after previous fractures was seen in all time periods. Interpretation — The 5-year implant survival rates were good with all prosthesis types, and markedly improved for anatomic total prostheses in the last 2 study periods. The better functional results with total shoulder prostheses than with hemiprostheses support the trend towards increased use of total shoulder prostheses.
    Full-text · Article · Nov 2014
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