Sunday, January 20, 2013

Total shoulder vs hemiarthroplasty at 10 years

Hemiarthroplasty vs total shoulder replacement for rotator cuff intact osteoarthritis: how do they fare after a decade?

This article presents a 10 year followup on 13 hemiarthroplasties and 20 total shoulder replacements - patients were randomized to the two groups at surgery after the glenoid had been exposed. There were four revisions among the hemiarthroplasty group and 2 among the total shoulders, each for glenoid loosening, one at 5 years and one at 7 years. Pain relief was better for the total shoulder group, although only 42% of the total shoulder group were pain free. The authors point out that the failed glenoid components were made from Hylamer, a type of polyethylene that is not longer used.

In the hemiarthroplasty group, no attempt was made to manage the glenoid side of the joint with glenohumeral osteoarthritis.

The authors are to be commended on a well-done randomized trial with long-term followup. 

We may again conclude that neither hemiarthroplasty nor resurfacing alone are ideal for managing most cases of glenohumeral arthritis. On the other hand, this study also shows that 10% of the total shoulders had failed at 7 years because of glenoid component loosening. Glenoid component failure remains the most serious complication of total shoulder arthroplasty.

Just to remind, a ream and run is not the same as a hemiarthroplasty, in that the glenoid side is treated as is further shown here. The glenoid erosion seen in 4 of the hemiarthroplasty cases in this series has not been part of our experience with the ream and run procedure.

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You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty,  and rotator cuff surgery.