Wednesday, August 10, 2016

Hemiarthroplasty vs total shoulder - an example of factors to consider.

A recent post (see this link) discussed an economic decision model for comparing hemiarthroplasty to total shoulder. While this article presented an interesting approach, our post surfaced some concerns about the methodology and generalizabilty of the results.

We concluded, "We might wonder why a surgeon would choose a HA over a TSA for patients such as those included in the recently published model, especially since the surgeon's reimbursement is greater for the TSA. Possible reasons would include surgeon inexperience with TSA, a diagnosis of avascular necrosis, complex anatomy or shoulder tightness that precluded the use of a TSA, patient's desire to avoid the activity limitations typically imposed on individuals with TSAs, or concern about cuff deficiency. Interestingly, each of these reasons could contribute to inferior outcomes, higher revision rates, and greater costs for patients having HA in contrast to other patients having TSA. "

We saw an illustrative case today of an active person who had done farm work for 20 years. She presented a year ago with an unusually advanced shoulder arthritis. She answered "no' to 11 out of 12 questions on the Simple Shoulder Test. Her x-rays at the time of presentation to us are shown below.

This shoulder was so tight and medially eroded, we elected a hemiarthroplasty rather than a total shoulder.

One year after surgery she answers "yes' to 10 of the 12 questions of the Simple Shoulder Test and is most pleased with the result.

We show this as an example of the ever present need to customize the treatment to the patient.