These authors present the outcomes of 56 hemiarthroplasties and 19 total shoulders with a minimum 20-year follow-up, or follow-up until reoperation.
Both HA and TSA showed significant improvements in pain scores (P < .001), abduction (P < .01), and external rotation (P = .02). Eighty-one percent of shoulders were rated much better or better than preoperatively. Modified Neer ratings were similar between groups (P = .41). Unsatisfactory ratings in HA were due to reoperations in 25 (glenoid arthrosis in 16) and limited motion, pain, or dissatisfaction in 11. Unsatisfactory ratings in TSA were due to reoperations in 6 (component loosening in 4) and limited motion in 5. Estimated 20-year survival was 75.6% (confidence interval, 65.9-86.5) for HAs and 83.2% (confidence interval, 70.5-97.8) for TSAs.
Comment:
This series is interesting because of the long term follow-up. However, it is to be recognized that the operations were done for a spectrum of patients and diagnoses quite different than what is typical in the U.S. today. Table I indicates that the average age was about 40 years of age and the diagnoses were predominantly post traumatic arthritis (24) and rheumatoid arthritis (17) for the 56 patients having hemiarthroplasty and post traumatic arthritis (6) and rheumatoid arthritis (12) for the 19 patients having total shoulders. We are a bit unclear on the math of this paper: for example if 25 of the 56 of the hemiarthroplasties (46%) had reoperations within 20 years, how is it possible that the 20 year survival was 75.6? If 6 of the 19 of the total shoulders (32%) had reoperations within 20 years, how is it possible that the 20 year survival was 83%?
The problems with any arthroplasty in younger individuals are (1) more complex pathology, (2) greater expectations, and (3) extended longevity.
The problem with long term follow-up studies is that the field has advanced substantially, so that the approaches before 1995 were probably quite different to those of 2015. On the other hand, the average time to glenoid failure is about 7 years after a total shoulder, so two-year follow-up studies are likely to present a too-rosy picture.
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