Sunday, February 16, 2014

Copeland cementless surface replacement - high revision rate

Mid-term results of Copeland shoulder cementless surface replacement arthroplasty from an independent centre

These authors reported their experience with 112 surface replacements in 101 patients between 2002 and 2007. 82 of the patients were female and 96 had primary arthritis. Of the 83 patients available for followup at an average of 72 months, 20% had over 2 mm of glenoid erosion. Microfracture had been performed in 38% and did not influence the progression of glenoid erosion.

Complications were:
Adhesion/stiffness 11%
Deep infection 0.9%
Loosening 3%
Cuff tear 4%
Periprosthetic fracture 3%
Glenoid erosion 21%
Chronic pain and stiffness 2%

Further surgery was performed in 27 (24.1%) shoulders, including 15 revisions, eight
arthrolyses and four subacromial decompressions. Revision to total shoulder arthroplasty was performed in 14 : 10 for glenoid erosion; one each for loosening, periprosthetic fracture, deep infection,
and chronic pain. One was revised to reverse arthroplasty for chronic pain.
The five year survival rate (with progressive glenoid erosion as the end point) was 67%. The implant survival rate was 82% at five years. A further 8 shoulders are awaiting revision.

Comment: While this procedure appears to be 'conservative', it does not effectively address the glenoid side of the joint, which is usually abnormal in glenohumeral arthritis. 

Furthermore, it does not allow for varying the head size, shape and offset, adjustments commonly necessary to optimize the kinematics of the arthritic shoulder. For comparison with a ream and run, see this post.

To learn more about shoulder arthritis and what can be done about it, see the Shoulder Arthritis Book.

To learn more about the rotator cuff, see the Rotator Cuff Book

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