Saturday, December 22, 2012

Resurfacing humeral prosthesis: do we really reconstruct the anatomy?

Resurfacing humeral prosthesis: do we really reconstruct the anatomy?

One of the options for reconstructing an arthritic humeral head is a resurfacing prosthesis. The goal is to resurface the humeral articular surface while preserving the remainder of the proximal humerus. Because of the retention of much of the humeral head and anatomic neck, access to the glenoid to address the glenoid articular surface is compromised. As a result, most resurfacings are done has hemiarthroplasties, even though in most cases of glenohumeral arthritis both the humeral and glenoid articular surfaces are involved. As pointed out in a previous post, hemiarthroplasty or resurfacing do not restore the desired glenohumeral contact.

In this article the authors reviewed 64 shoulders with at least two years followup after resurfacing for 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.

According to the Walch et al classification, 45 shoulders had central wear (A) and 14 and eccentric wear (B) while 5 had dysplastic glenoids.

The followup Constant score averaged 68 ± 20 points (range 29-100). Quick-DASH score averaged 28 ± 21 points (range, 0-88 points). Neer ratings were very satisfactory in 28 shoulders, satisfactory in 16, and nonsatisfactory in 20.

Postoperative radiographs showed showed a tendency to glenoid wear which appeared to correlate with with reappearance of pain.

The authors conclude that a resurfacing shoulder implant without glenoid resurfacing
leads to glenoid wear.

Thus the question in resurfacing is less about reconstructing humeral anatomy and more about care of the glenoid side of the arthritic glenohumeral joint.


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