Monday, June 17, 2013

The role of eccentric and offset humeral heads in total shoulder replacement

The role of eccentric and offset humeral head variations in total shoulder arthroplasty.

The stated goal of this paper was to  "determine whether prosthetic variety has led to better outcomes, has led to similar outcomes facilitating joint reconstruction, or created any unanticipated complications".

In this series of 160  primary total shoulder arthroplasties operated between 2001 and 2005, head geometry was selected intraoperatively during trialing based on a complementing relationship to the glenoid throughout the range of shoulder motion while allowing for both mobility and stability. The surgeons ended out using  52 standard, 60 eccentric, and 48 offset (increased height) humeral heads.  It is of interest that the authors used something other than the 'standard' head in 2/3rds of the cases. Average followup was 4.7 years (range 0.8 to 8.3 years).

Postoperative radiographic analysis of the overall group showed moderate to severe glenohumeral subluxation in 20%, grade 4 or 5 glenoid lucent lines in 8%, shift in glenoid position in 9%, and glenoid at risk in 12% of the cases. 6% had painful glenoid loosening and 4% had reoperations, mostly for glenoid loosening. 2 patients had transient brachial plexopathy.

The authors found no difference in outcomes for the different head configurations.

This paper did not, however, test 'whether prosthetic variety has led to better outcomes': there was no evidence provided that patients treated with a system allowing prosthetic variety did better, worse or the same as those treated with a system that did not allow prosthetic variety.

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