This paper summarizes the results of questionnaires sent to patients registered in the Norwegian Arthroplasty Register with four different types of shoulder arthroplasty. Outcomes were characterized with the Oxford Shoulder Score and the EuroQol.
Noting that this was not a matched or controlled study, the authors found that conventional total shoulders provided the best improvement in pain, function and QoL in patients with osteoarthritis. Reverse prostheses yielded best results in patients with rheumatoid arthritis and post-traumatic arthritis, presumably because the cuff status in many patients with these conditions is compromised. Hemiarthroplasty or resurfacing without attention to the glenoid side of the arthritic joint yielded the worst results in each diagnostic group.
The authors assessed the weaknesses of the study, including a response rate of 65%, the retrospective collection of preoperative scores (2 to 16 years earlier), and the non-random allocation of prosthesis type (i.e. is it possible that total shoulder arthroplasty was preferentially performed on patients with the simplest of shoulder pathologies?).
It is of interest that the numbers of each procedure are quite different: 408 hemiprostheses, only 86 total shoulders, 195 resurfacings, and 170 reverse total shoulders. Seventy percent of the cases apparently did not have a glenoid arthroplasty. In that this report is based on a registry, one would wonder what factors, perhaps including surgeon experience, went in to the selection of the prosthesis used in each case. It would be of interest to know the distribution among the four types of surgery in the 1,865 patients enrolled in the registry in that this would provide a view of the nature of arthroplasty practice in Norway.
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