Monday, December 31, 2012

Shoulder hemiarthroplasty

Shoulder hemiarthroplasty: outcomes and long-term survival analysis according to etiology.

272 shoulders with fracture sequelae (n=73), primary osteoarthritis (n=67), cuff tear arthropathy (n=43), avascular necrosis (n=40), rheumatoid arthritis (n=31), and other (n=18) had humeral hemiarthroplasty between May 1988 and December 2000. Results were evaluated in 2009. 30 prostheses required removal. 139 were evaluated after at least 8 years (mean follow-up, 134 months) (59 had died and 47 were lost to followup).

Ten-year prosthesis survival was 88.13% overall, 100% in the rheumatoid arthritis group, 94.9% in the avascular necrosis group, 94.2% in the primary osteoarthritis group, 81.5% in the cuff tear arthropathy group, and 76.8% in the fracture sequelae (P=0.05). The mean Constant-Murley score after 8 years or more was 70.1 in avascular necrosis, 60.7 in primary osteoarthritis, 57.7 in fracture sequelae, 55.3 in rheumatoid arthritis, and 46.2 in cuff tear arthropathy (P=0.0006). The complication rate with the initial population as the denominator was 24.7% in fracture sequelae, 18.6% in cuff tear arthropathy, 15% in avascular necrosis, 8.9% in primary osteoarthritis, and 3.2% in rheumatoid arthritis.

43 out of 272 cases had complications. Glenoid erosion was noted in 17 cases, stiffness in 8, cuff tears in 4, infection in 3, humeral fracture in 3, anterior instability in 2, and stem loosening in 2.

8 out of 73 fracture sequelae cases had complications, as did 6 out of 67 osteoarthritis cases, 8 out of 43 cuff tear arthropathy cases and 6 out of 40AVN cases.

The prosthesis survival rates at 10 years were 100% for rheumatoid arthritis, 95% for osteoarthritis, 94% for avascular necrosis, 82% for cuff tear arthropathy and 77% for fracture sequelae.

The average Constant scores at latest followup were 70 for avascular necrosis, 61 for osteoarthritis, 58 for fracture sequelae, 55 for rheumatoid arthritis, and 46 for cuff tear arthropathy.

These results are better than many reported for hemiathroplasty without attention to the glenoid side of the joint. As the authors point out, patients with hemiarthroplasty are spared the risk of glenoid component failure - a problem especially important for younger more active individuals.

What we do not know about the patients in this study is why they had hemiarthroplasty rather that total shoulder or reverse total shoulder prostheses and how these results compare to the results from comparable patients from the same study group having other forms of shoulder arthroplasty. The surgeons in this group are eminently qualified in all forms of shoulder reconstruction. This comment was also made about a recent report of shoulder arthroplasty from Norway.

The relatively poorer results for patients with fracture sequelae having hemiarthroplasty are not substantially different than those for patients having other procedures for this complex diagnosis. 

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