These authors performed a retrospective multicenter study for all patients aged 60 years or less undergoing either hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis with a minimum of 24-month follow-up.
Some of the clinical outcomes at final followup were better for the patients having total shoulder arthroplasty.
A total of 202 patients with a mean age of 55.3 years (range, 36-60 years) underwent TSA with a mean follow-up of 9 years (range, 2-24.7 years). Revision arthroplasty was performed in 33 (16.3%) shoulders, with glenoid failure associated with the revision in 29 shoulders (88%). TSA survivorship analysis demonstrated 95% free of revision at 5 years, 83% at 10 years, and 60% at 20-year follow-up.
A total of 31 patients with a mean age of 52.5 years (range, 38-60 years)(significantly younger than the TSA group p = .003) underwent HA with a mean followup of 8.7 years (range, 2-21.4 years). Revision arthroplasty was performed in 5 (16.1%) shoulders, with glenoid erosion as the cause for revision in 4 shoulders (80%). HA survivorship analysis demonstrated 84% free from revision at 5 years and 79% at the final follow-up.
Of the patients treated with TSA, 10 (5%) required a reoperation and 33 (16.3%) required a revision
shoulder arthroplasty. Of the patients treated with HA, 4 (12.9%) required a reoperation and 5 (16.1%) required revision shoulder arthroplasty.
Comment: This is an interesting study. Additional information would be helpful. For example, the reasons for choosing a TSA or a HA are not provided. Furthermore it is not clear that the shoulders were comparable, for example the glenoid types are not provided for the two groups. It is possible that the more challenging glenoid types (B2, B3) were managed with HA because of difficulties inserting a glenoid component.
We also do not have details on the type of genoid components used or whether reaming of the glenoid was carried out in the HA group to distribute the load from the humeral implant.
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