Long-Term Follow-up of Shoulder Hemiarthroplasty for Glenohumeral Osteoarthritis JBJS

Long-Term Follow-up of Shoulder Hemiarthroplasty for Glenohumeral Osteoarthritis JBJS

This Level IV study reports results at an average of 17 years on 25 of 31 shoulders having hemiarthroplasty for glenohumeral arthritis between June 1990 and December 1994. Eight of these shoulders had revisions (three with concentric glenoid wear and five with eccentric glenoid anatomy). Patients having revision were younger than those not having revision surgery. Patients with secondary arthritis (post-traumatic arthritis, capsulorrhaphy arthropathy, osteonecrosis and post-septic arthritis) had poorer functional outcomes than those with primary osteoarthritis.

This paper brings up some questions of interest. The center in which this study was generated is one of the major centers performing total shoulder arthroplasty in the world, so what factors led the surgeons to perform hemiarthroplasty on these patients? Since glenohumeral arthritis affects both sides of the joint, under what circumstances is a hemiarthroplasty the preferred treatment? Twenty-one of the thirty patients (70%) were treated for conditions such as post-traumatic arthritis, capsulorrhaphy arthropathy, osteonecrosis and post-septic arthritis – all of which are associated with a poor prognosis; is there evidence that a total shoulder would have been more effective in these shoulders? Did the patients having conversion of the hemiarthroplasty to total shoulder arthroplasty improve afterwards?

We can conclude from this study that the shoulders of younger patients who often have complex forms of arthritis – especially those with distorted glenoid bony anatomy - are likely to have poor results with humeral hemiarthroplasty. In the absence of a comparable group of patients having other forms of management, we cannot conclude on how these difficult shoulders can best be managed. The paper does not address what the authors describe in the Introduction as the 'major controversy surrounding the use of hemiarthroplasty as compared to total shoulder arthroplasty for glenohumeral osteoarthritis' in that it did not report the results for the similar patients with similar diagnoses having total shoulder arthroplasty between 1990 and 1994 at this institution.

Wouldn't it be more interesting if these authors had included of all patients with the different types of secondary arthritis having either hemiarthroplasty or total shoulder arthroplasty between 1990 and 1994 so that the pretreatment characteristics (including glenoid anatomy) and post-treatment results of each could be compared?

----

If you have suggestions for topics you'd like us to address in this blog, please send an email to
shoulderarthritis@uw.edu

Use the "Topics" box to the right to find other posts of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

See the countries from which our readers come on this post.