Saturday, January 26, 2013

Total shoulder design, does it matter?

Impact of prosthetic design on clinical and radiologic outcomes of total shoulder arthroplasty: a prospective study

It seems that each year brings new shoulder athroplasty designs. Each new design brings with it the cost of design, manufacture, FDA approval, marketing, royalties, consultancy, and the learning curve of using it. These incremental costs become part of the nation's health care expenditure.

This is a study comparing the two year clinical and radiologic outcomes of 3 different prosthetic designs, the Neer II system, the Bigliani-Flatow (BF), and a stemless prosthesis, the Total Evolutive Shoulder System (TESS).

This was not a randomized study and different surgeons used the different prostheses.

There was less range of external rotation motion and a higher incidence of lucent lines in the Neer II group. While the authors report the outcomes as not being different among the prostheses, the improvement over the preoperative WOOS score was 62 for the Neer, 55 for the BF and 48 for the TESS. See our chart showing their preop score in blue and two year score in red.

The rate of glenoid perforation for the BF and TESS systems was three times that of the Neer prosthesis. The patient satisfaction at two years was not different among the three groups.

On the basis of the foregoing, the data do not support the view that the newer prostheses yield better improvement in patient outcomes. More such comparison studies are needed to demonstrate whether or not we are making progress in component design and whether any improvement is worth the cost.

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