Self-assessed and radiographic outcomes of humeral head replacement with nonprosthetic glenoid arthroplasty
These authors start their paper with the statement " Long-term experience with total shoulder arthroplasty has led to concern for loosening of the glenoid component, with a recent series of 15- to 20-year follow-up demonstrating a 73% rate of glenoid loosening and a 31% rate of revision"
They recognize the potential role of nonprosthetic glenoid arthroplasty (the ream and run procedure) in addressing the limitations of total shoulder arthroplasty and hemiarthroplasty in individuals seeking high levels of shoulder activity; however up to the present, all of the reports of the effectiveness of this approach have come from the University of Washington.
They present a case series of 17 (11 male and 6 female) shoulders average age 55 years (range 24-69) with a minimum of two year followup after humeral hemiarthroplasty with nonprosthetic glenoid arthroplasty. 8 had prior surgeries (cuff repair, instability surgery, debridement). Selection for this procedure was based on patient activity expectations that included work or sports involving impact, heavy lifting, or strenuous use of the upper extremity; patient wish to avoid total shoulder arthroplasty for various reasons, including activity level, age, and the desire to avoid the risks associated with a prosthetic glenoid prosthesis. Patients understood the potential for both longer recovery time and functional outcome less than that expected for total shoulder arthroplasty.
X-ray analysis on standardized axillary views included assessment of glenohumeral subluxation (translation of the center of the humeral head relative to the center of the glenoid), glenoid erosion (distance from the posterior edge of the glenoid to a line perpendicular to the scapular body axis passing through the anterior glenoid margin), and the glenohumeral joint space. The glenoid retroversion angle and glenoid morphology were also measured as previously described.
Importantly, the glenoid reaming was conservative with priority given to preservation of glenoid bone stock rather than to 'correction' of glenoid version. The diameter of the glenoid reamer was 2 mm greater than that of the humeral head component. Range of motion exercises were started the day of surgery.
The Simple Shoulder Test (SST) score improved from mean 3.2 ± 3.1 preoperatively to 10.0 ± 2.6 at latest follow-up (P < .0001). 14 of 17 patients with a mean followup of 4 years had an improvement of >30% of preoperative SST score. American Shoulder and Elbow Surgeons score improved from mean 42 ± 23 to 90 ± 13 (P < .0001). VAS scores for pain and instability as well as active elevation and external rotation were also significantly improved. Three patients had revision surgery: one after re-injury in an auto accident, one because of pain and one because instability. Eighty-two percent of patients achieved the defined minimum clinically important difference in SST score (Maximum SST score - Preoperative SST score X 30%) and avoided further surgery.
Male patients had higher SST scores and greater external rotation at latest follow-up. Importantly, they observed that patients with concentric glenoid morphology preoperatively did not demonstrate results superior to those of patients with eccentric glenoids.
Comment: It is of interest that the technique and the results of this series are very similar to those we have reported previously. Our hope is that these and other surgeon investigators will continue to help refine the indications and the technique for this procedure.
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