Sunday, November 6, 2016

Is resurfacing hemiarthroplasty a conservative procedure for young patients?

Outcome of Revision Shoulder Arthroplasty After Resurfacing Hemiarthroplasty in Patients with Glenohumeral Osteoarthritis.

These authors reviewed all patients with osteoarthritis reported to the Danish Shoulder Arthroplasty Registry from 2006 to 2013. There were 1,210 primary resurfacing hemiarthroplasties, of which 107 cases (9%) required a revision surgical procedure, defined as the removal or exchange of the humeral component or the addition of a glenoid component. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate outcome at 1 year.

The median WOOS of revision arthroplasty after failed resurfacing hemiarthroplasty was 62 points (interquartile range, 40 to 88 points). Of the 80 cases that had follow-up, 33 (41%) had an unacceptable outcome, defined as a WOOS of ≤50 points.

Of the 107 cases that required a revision surgical procedure, 11 arthroplasties (10%) required a further revision surgical procedure: to a stemmed hemiarthroplasty (n = 39), to an anatomic total shoulder arthroplasty (n = 31), or to a reverse shoulder arthroplasty (n = 30). In 7 cases, the revision arthroplasty design was unknown. 

The median WOOS of patients who underwent revision stemmed hemiarthroplasty (48 points) was significantly inferior (p = 0.002) to that of patients who underwent primary stemmed hemiarthroplasty (75 points); the median WOOS of patients who underwent revision anatomic total shoulder arthroplasty (74 points) was also significantly inferior (p = 0.007) to that of patients who underwent primary anatomic total shoulder arthroplasty (93 points). 

The authors conclude that the outcome of revision shoulder arthroplasty after failed resurfacing hemiarthroplasty was variable and, in many cases, disappointing. It is important that resurfacing hemiarthroplasty is used for the correct indications and with adequate technique and skill. When resurfacing hemiarthroplasty is used in the treatment of osteoarthritis, revision cannot be counted upon as a fallback.
The authors show a diminishing use of the resurfacing arthroplasty with time.

As well as limited survivorship of the resurfacing hemiarthroplasty in patients 55 years of age and younger.

Of interest is that the overall WOOS scores for primary resurfacing hemiarthroplasties is similar to that for primary stemmed arthroplasties. However the results of primary resurfacing in younger patients are worse. The best results were obtained with a primary anatomic total shoulder.

Comment: These results seem to suggest that hemiarthroplasty alone (whether resurfacing or stemmed) may be insufficient treatment for individuals with glenohumeral osteoarthritis, a condition that affects both the glenoid and humeral articular surfaces. 

What is lacking in this study is information on the mode of failure of these hemiarthroplasties. Also lacking is a comparison of the results of primary resurfacing hemiarthroplasty to primary stemmed arthroplasty. 

This study does provide evidence that salvage of a failed resurfacing hemiarthroplasty is often unsuccessful.

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