Friday, April 11, 2014

Resurfacing hemiarthroplasty for osteoarthritis of the shoulder - is there any advantage?

Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder

These authors evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis performed between January 2006 and December 2010 from the Danish registry.

A complete Western Ontario Osteoarthritis of the Shoulder questionnaire was returned by 688 patients (82.2%). The mean WOOS at followup was 67 (0 to 100). The preoperative scores were not provided so that the amount of improvement is not known. A total of 63 hemiarthroplasties (7.5%) required revision; the cumulative five-year rate of revision was 9.9%. 

Patients aged < 55 years had a statistically significant inferior clinical outcomes compared with older patients (mean difference 14.2 (8.8; 95% CI 19.6; p < 0.001).

Comment: While some surgeons are attracted to the concept of a resurfacing hemiarthroplasty as a 'conservative' arthroplasty for managing glenohumeral arthritis, it has several shortcomings. (1) The resurfacing hemiathroplasty does not manage the glenoid aspect of glenohumeral arthritis. (2) While a stemmed humeral component allows for modification of the head size, shape and position to optimize shoulder mobility and stability, this is not possible with a resurfacing hemiarthroplasty.

In this retrospective series, the annualized revision rate was 2% per year. The most common reasons for revision were glenoid problems, rotator cuff dysfunction, 'technical failure', pain, infection, loosening, and instability.

We revise quite a few failed resurfacing arthroplasties. Here are the preoperative and postoperative x-rays from a case a few weeks ago that was revised because of pain and stiffness in a 50 year old woman. At the time of her presentation she could perform 0 of the 12 functions of the Simple Shoulder Test.

Two days after her revision to a total shoulder she had assisted elevation to 160 degrees while taking only minimal pain medication.

Contrast this scenario with that shown in the next post.


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