Tuesday, January 8, 2013

Ten year outcomes of total shoulders

Results of Cemented Total Shoulder Replacement with a Minimum Follow-up of Ten Years

This is a report on the clinical and radiographic long-term outcomes of 39 shoulders treated with a third-generation cemented total shoulder replacement with a keeled all polyethylene flat backed cemented glenoid component (Aequalis Total Shoulder) and followed for at least ten years.

On average, the Constant Score increased from  27 points preoperatively to  61 points postoperatively. Shoulder flexion increased from 84° preoperatively to 133° postoperatively. Although no humeral components were loose, 36% of the glenoid components were radiographically loose at the time of follow-up. Kaplan-Meier survivorship of the glenoid component was 100% after thirteen years with revision as the end point, whereas survivorship with radiographic loosening as the end point was only 48% after thirteen years.  Cranial migration of the humerus was seen in 69% of the cases. The migration was mild in ten cases (37%), moderate in twelve (44%), and severe in five (19%).

This is an important study. The patterns of glenoid radiographic loosening included superior rocking horse loosening in cases of superior migration resulting from presumed rotator cuff failure

 and posterior rocking horse loosening.

There was no significant difference in the clinical outcomes between patients with and those without radiographic loosening of the glenoid component. There was a trend toward inferior outcomes in cases with severe migration.

It was of interest to see that the onset of radiographic loosening was often after the 10 year mark.

Only one of these patients has required revision surgery.


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