Long-term results and patient satisfaction after shoulder resurfacing

Long-term survival of resurfacing humeral hemiarthroplasty

INTRODUCTION

The indication for shoulder resurfacing arthroplasty is controversial, and survival of these implants is somewhat inconsistent. This study aimed to evaluate the long-term survivorship of resurfacing humeral head implants (RHHIs) and determine risk factors for complications and revisions.

MATERIALS AND METHODS

This retrospective cohort study consisted of 275 cases and two types of RHHIs. The survival rate was evaluated using the Kaplan-Meier method and Cox regression for risk factor analysis. Demographic factors were studied, and the change in the humerus centre of rotation (COR) was measured.

RESULTS

The mean follow-up time was 8.7 years (SD 2.7 months, range 2.8-15.9 years). The mean age of the patients was 67.6 years (SD 9.6, range 33.5-84.9). Ten-year cumulative RHHI survival was 94.1%. The cumulative estimate without any complication was 98.9% at 5 years, 80.0% at 10 years and at 15 years it was 61.5%. The most common complication was persistent pain in 13.8% of the RHHIs. The risk factors for complications and revisions were implant type, preoperative conditions and change of COR > 5 mm.

CONCLUSIONS

RRHIs showed excellent long-term survival, but many complications were found. The most common complication was persistent pain, which seemed to be caused by a change of COR and was more related to one type of implant.

Poor evidence is used to support commercial payers' coverage policies for shoulder arthroplasty

BACKGROUND

The incidence of shoulder arthroplasty has continued to increase over the past decade. In response, commercial payers have implemented strategies to control the medical requirement of these surgeries in attempt to contain the growing costs. For example, most payers require a prolonged trial of conservative management prior to shoulder arthroplasty for patients who may otherwise be surgical candidates. However, little is known regarding the evidence used to support these indications. The purpose of this study was to analyze the references used by commercial payers to substantiate their coverage policies for shoulder arthroplasty.

METHODS

Ten of the leading commercial payers for total shoulder arthroplasty were identified. Publicly available coverage policies were searched on the internet or requested directly from the payer via email or telephone. Cited references were reviewed independently by two authors for type of document, level of evidence, and mention of the efficacy of conservative management.

RESULTS

A total of 5 coverage policies were obtained with 118 references. The most common reference type was primary journal article (n = 70; 59.3%) followed by review or expert opinion articles (n = 35; 29.7%). Most references were of level IV evidence (n = 60; 52.2%), with only 6 (5.2%) of level I or II evidence. Only 4 (3.5%) references mentioned the efficacy of conservative management in patients who may be candidates for shoulder arthroplasty.

CONCLUSION

The majority of references used to substantiate the coverage policies for shoulder arthroplasty among major commercial payers within the United States are of low scientific evidence and fail to demonstrate the success of required nonoperative intervention strategies. Our study underscores the need for high-quality, comparative trials that evaluate the outcomes of conservative management vs. shoulder arthroplasty in end-stage glenohumeral osteoarthritis patients in order to determine the most cost-effective treatment algorithm.

Cementless Metal-Free Ceramic-Coated Shoulder Resurfacing

Shoulder resurfacing is a versatile, bone-conserving procedure to treat arthritis, avascular necrosis, and rotator cuff arthropathy. Shoulder resurfacing is of interest to young patients who are concerned about implant survivorship and those in need of a high level of physical activity. Using a ceramic surface reduces wear and metal sensitivity to clinically unimportant levels. Between 1989 and 2018, 586 patients received cementless, ceramic-coated shoulder resurfacing implants for arthritis, avascular necrosis, or rotator cuff arthropathy. They were followed for a mean of 11 years and were assessed using the Simple Shoulder Test (SST) and Patient Acceptable Symptom State (PASS). CT scans were used in 51 hemiarthroplasty patients to assess the glenoid cartilage wear. Seventy-five patients had a stemmed or stemless implant in the contralateral extremity. A total of 94% of patients had excellent or good clinical results and 92% achieved PASS. 6% of patients required a revision. A total of 86% of patients preferred their shoulder resurfacing prosthesis over a stemmed or stemless shoulder replacement. The glenoid cartilage wear at a mean of 10 years was 0.6 mm by a CT scan. There were no instances of implant sensitivity. Only one implant was removed due to a deep infection. Shoulder resurfacing is an exacting procedure. It is clinically successful, with excellent long-term survivorship in young and active patients. The ceramic surface has no metal sensitivity, very low wear, and, therefore, it is successful as a hemiarthroplasty.

Long-term results of the uncemented resurfacing shoulder hemiarthroplasty (Global Conservative Anatomic Prosthesis)

BACKGROUND

Treatment with uncemented resurfacing shoulder hemiarthroplasty has proved to be viable for patients with end-stage osteoarthritis at short- and mid-term follow-up. This study was essential to determine whether those outcomes will endure. This study presents the long-term results of the Global Conservative Anatomic Prosthesis (CAP) uncemented resurfacing shoulder hemiarthroplasty (DePuy Synthes, Warsaw, IN, USA).

METHODS

All patients with a diagnosis of glenohumeral osteoarthritis and an intact and clinically sufficient rotator cuff who underwent uncemented resurfacing shoulder hemiarthroplasty between 2007 and 2009 were included. The data of all patients who completed the 10-year follow-up assessments were used for analysis. The visual analog scale pain score, Dutch version of the Simple Shoulder Test score, Constant score, Short Form 12 scores, and physical examination findings were evaluated preoperatively and postoperatively on an annual basis. All complications and revisions were documented. Radiographs were evaluated for loosening, luxation or subluxation, migration, and glenoid erosion.

RESULTS

Of 48 shoulders, 23 (48%, 18 women and 5 men) were available for the 10-year follow-up assessments and their data were used for analysis. The main reasons for dropout were revision (27%) and death (10%). The mean follow-up period of the remaining patients was 10.9 years (range, 9-13 years). The visual analog scale pain score (from 6.5 ± 2.1 to 0.7 ± 1.6, P < .001), Simple Shoulder Test (Dutch version) score (from 22% ± 22% to 79% ± 22%, P < .001), Constant score (from 40 ± 29 to 70 ± 8, P < .001), and Short Form 12 physical score (from 36 ± 7 to 41 ± 12, P = .001) improved significantly compared with preoperative scores. Revision surgery was performed in 13 of the initial 48 shoulders (27%). Most revisions were seen within 7 years postoperatively.

CONCLUSION

Two revisions have been performed in the mid-term to long term because of increased functional outcome scores and the absence of signs of loosening. Nevertheless, the high overall revision rate of 27% between short- and long-term follow-up reflects the need to limit the use of uncemented resurfacing shoulder hemiarthroplasty for the treatment of glenohumeral osteoarthritis.

Inlay total shoulder arthroplasty for primary glenohumeral arthritis

Background

Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid replacement has been introduced in the past; however, clinical evidence remains limited. We hypothesized that patients with advanced glenohumeral arthritis demonstrate significant improvements in pain and function.

Methods

Prospective patient-reported outcomes (PROs) included the American Shoulder and Elbow Surgeons score, a pain visual analog scale, and satisfaction. Range of motion was compared to the preoperative status. A sensitivity analysis examined responder rates and compared them to literature thresholds using the minimal clinically important difference and substantial clinical benefit. The preoperative glenoid morphology was determined using the Walsh classification. Zone-specific periprosthetic radiolucent lines were quantified at the last follow-up.

Results

Thirty-nine shoulders in 36 patients (3 bilateral) with a mean age of 65.9 years (26 males, 13 females) and a mean follow-up of 41.0 months were included. Ninety-three percent had grade III osteoarthritis, and 7% grade II. The glenoid Walsh classification included A1 (25%), A2 (25%), B1 (22%), B2 (25%), and C (3%). All PROs improved significantly (P < .001) with a mean American Shoulder and Elbow Surgeons score from 30.4 to 77.1, a pain visual analog scale from 8.1 to 1.5, and excellent (9.1/10) patient satisfaction. PRO-related responder rates for minimal clinically important difference and substantial clinical benefit were ≥85%. Forward elevation improved from 107° to 155°, and external rotation from 22° to 51°. One intraoperative glenoid rim fracture led to advanced radiolucency; no other clinically relevant lucency was observed.

Conclusion

Treatment with inlay total shoulder arthroplasty demonstrated significant functional improvement, excellent pain relief, and patient satisfaction in patients with advanced shoulder arthritis and various glenoid morphology types. Our initial results provide further support for this new option in primary shoulder replacement.

Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure

PURPOSE

Literature describes the concern of an overstuffed shoulder joint after a resurfacing humeral head implant (RHHI). The purpose of this study was to evaluate inter-observer variability of (1) the critical shoulder angle (CSA), (2) the length of the gleno-humeral offset (LGHO), and (3) the anatomic center of rotation (COR) in a patient population operated with a Global Conservative Anatomic Prosthesis (CAP) RHHI. The measurements were compared between the revision and non-revision groups to find predictive indicators for failure.

METHODS

Pre- and postoperative radiographs were retrieved from 48 patients who underwent RHHI from 2007 to 2009 using a Global CAP hemiarthroplasty for end-stage osteoarthritis. This cohort consisted of 36 females (12 men) with a mean age of 77 years (SD 7.5). Two musculoskeletal radiologist and two specialized shoulder orthopedic surgeons measured the CSA, LGHO, and COR of all patients.

RESULTS

The inter-observer reliability showed excellent reliability for the CSA, LGHO, and the COR, varying between 0.91 and 0.98. The mean COR of the non-revision group was 4.9 mm (SD 2.5) compared to mean COR of the revision group, 8 mm (SD 2.2) (p < 0.01). The COR is the predictor of failure (OR 1.90 (95%Cl 1.19-3.02)) with a cut of point of 5.8 mm. The mean CSA was 29.8° (SD 3.9) There was no significant difference between the revision and non-revision groups (p = 0.34). The mean LGHO was 2.6 mm (SD 3.3) post-surgery. The mean LGHO of the revision group was 3.9 (SD 1.7) (p = 0.04) post-surgery. Despite the difference in mean LGHO, this is not a predictor for failure.

CONCLUSION

The CSA, LGHO, and COR can be used on radiographs and have a high inter-observer agreement. In contrast with the CSA and LGHO, we found a correlation between clinical failure and revision surgery in case of a deviation of the COR greater than 5 mm.

TRIAL REGISTRATION

Institutional review board, number: ACLU 2016.0054, Ethical Committee number: CBP M1330348. Registered 7 November 2006.

Mid- to long-term follow-up of shoulder arthroplasty for primary glenohumeral osteoarthritis in patients aged 60 or under

BACKGROUND

Shoulder arthroplasty in young patients with primary glenohumeral osteoarthritis is an area of continued controversy.

METHODS

A retrospective multicenter study was performed 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. Clinical and functional outcomes, complications, and need for revision surgery were analyzed. Survivorship analysis using revision arthroplasty as an endpoint was determined.

RESULTS

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) underwent HA with a mean follow-up 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. TSA resulted in a significantly better range of motion, pain, subjective shoulder value, and Constant score compared with HA.

CONCLUSION

In young patients with primary glenohumeral osteoarthritis, TSA resulted in significantly better functional and subjective outcomes with no significant difference in longitudinal survivorship compared with patients treated with HA.

Preoperative Comorbidities and Postoperative Complications Do Not Influence Patient-Reported Satisfaction Following Humeral Head Resurfacing: Mid- to Long-term Follow-up of 106 Patients

Background

Humeral head resurfacing (HHR) has emerged as an alternative treatment for glenohumeral osteoarthritis. We investigated the outcomes of HHR using validated patient-reported outcome (PRO) measures.

Methods

A retrospective review was performed on 213 patients who underwent HHR. A PRO follow-up was performed by administering a questionnaire including the American Shoulder and Elbow Society (ASES) score, Brophy activity survey, short form of the Disabilities of the Arm, Shoulder and Hand (quickDASH) survey, and general shoulder function. PRO scores were stratified by comorbidities and complications.

Results

Survey responses were received from 106 patients (51%), with a mean follow-up of 5.6 ± 1.8 years (range: 9 months to 6.1 years). Preoperative comorbidities were associated with significantly higher quickDASH scores. Postoperative complications were associated with significantly higher rates of current pain, higher visual analog scale scores, night pain, lower subjective shoulder values, and lower ASES pain and total scores. No differences in patient satisfaction were identified between the cohorts with and without preoperative comorbidities and between the cohorts with and without postoperative complications.

Conclusion

In our cross-sectional analysis of mid- to long-term outcomes following HHR, preoperative comorbidities, or postoperative complications had no impact on patient-perceived postoperative satisfaction or most PROs. HHR is clinically viable in a wide variety of patients. Future work is necessary to compare the efficacy of HHR compared with more traditional total shoulder arthroplasty and stemmed hemiarthroplasty regarding long-term outcomes and appropriate indications.

Progressive glenoid bone loss caused by erosion in humeral head resurfacing

BACKGROUND

Cementless surface replacement of the shoulder represents an alternative to conventional stemmed anatomic prostheses. Glenoid erosion is a well-known complication in hemiarthroplasty. However, there is limited data concerning radiographic evaluation and prognostic factors for this phenomenon.

OBJECTIVES

The aim of our study was to determine the development of glenoid erosion following shoulder resurfacing using a new measurement technique and detect potential prognostic factors.

MATERIALS AND METHODS

We performed a retrospective analysis on 38 shoulders undergoing humeral head resurfacing with a mean follow-up of 65.4 ± 43 months. Clinical and radiographic evaluation followed a standardized protocol including pre- and postoperative Constant score, active range of motion, and X‑rays in true anteroposterior view. Three independent observers performed measurements of glenoid erosion.

RESULTS

We found good interobserver reliability for glenoid erosion measurements (intraclass correlation coefficient [ICC] 0.74-0.78). Progressive glenoid erosion was present in all cases, averaging 5.5 ± 3.9 mm at more than 5 years' follow-up. Male patients demonstrated increased glenoid bone loss within the first 5 years (p < 0.04). The mean Constant score improved to 55.4 ± 23.6 points at the latest follow-up. Younger age was correlated to increased functional outcome. Revision rate due to painful glenoid erosion was 37%.

CONCLUSIONS

Glenoid erosion can be routinely expected in patients undergoing humeral head resurfacing. Painful glenoid erosion leads to deterioration in functional outcome and necessitates revision surgery in a high percentage of cases.

Revision of Failed Resurfacing Hemiarthroplasty: Midterm Results, Survival, and Group Comparison

Shoulder arthroplasty is a valuable option for treating glenohumeral osteoarthritis. Revision surgery for a failed shoulder arthroplasty is associated with difficult procedures, complications, and worse outcomes. Compared with a total joint arthroplasty, a resurfacing prosthesis has the supposed advantages of limited perioperative complications and little bone loss during revision. The aim of this study was to describe patient-reported outcome measures of revision surgery from failed uncemented Global CAP (DePuy, Warsaw, Indiana) resurfacing hemiarthroplasty to total shoulder or reverse shoulder arthroplasty. Eleven patients from 2 collaborating institutes had a failed resurfacing prosthesis. Revision surgery was performed to total shoulder prosthesis in 7 patients and to reverse shoulder prosthesis in 3 patients. Data were missing for 1 patient. Outcomes were monitored using the Constant-Murley score, Dutch Simple Shoulder Test, Short Form-12, visual analog scale for pain, and physical examination. Mean time to revision was 54 months (SD, 15.6 months). No perioperative complications occurred. At 42 months of follow-up (SD, 15.9 months), clinical and patient-reported outcomes were excellent. The Constant-Murley score improved a significant 29 points (P<.01). The visual analog scale pain score decreased from 55 to 5 points (P<.01), and the Dutch Simple Shoulder Test and Short Form-12 scores improved significantly (P≤.02). Five-year survival was 82.6% (95% confidence interval, 71.6%-93.6%). At 3.5-year follow-up, clinical and patient-reported outcome measures had satisfying results. [Orthopedics. 2019; 42(1):e111-e117.].

Results of partial resurfacing of humeral head in patients with avascular necrosis

OBJECTIVE

The aim of this study was to report the short-term results and complications of partial humeral head resurfacing (HemiCup^®) in patients treated by avascular necrosis.

MATERIAL AND METHODS

Between 2010 and 2014, 9 patients who underwent partial resurfacing of humeral head were evaluated. All the patients were treated by avascular necrosis. The mean follow-up was 44 months (minimum 24 months). The average age was 47 years (range 32-57 years). The patients were evaluated clinically and radiologically. Complications were reported.

RESULTS

The patients had a significant improvement in functional scores and mobility between the pre-operative and last follow-up control. The Constant score improved from 35 to 79 points (P<.001), ASES score improved from 31 to 76 points (P<.001), forward flexion and external rotation improved from 101 to 150° (P<.001), and from 24 to 45° (P<.001), respectively. One patient presented symptomatic glenoid wear during follow-up, requiring revision surgery.

CONCLUSION

In our patients treated by avascular necrosis, the partial resurfacing of humeral head (HemiCup^®) demonstrated a significant improvement in functional scores and mobility with an average follow-up of 44 months.

Low inter-observer agreement among experienced shoulder surgeons assessing overstuffing of glenohumeral resurfacing hemiarthroplasty based on plain radiographs

Background

In a clinical setting, a visual evaluation of post-implant radiographs is often used to assess the restoration of glenohumeral joint anatomy after resurfacing hemiarthroplasty and is a part of the decision-making process, in combination with other parameters, when evaluating patients with inferior clinical results. However, the reliability of this method of visual evaluation has not been reported. The aim of this study was to investigate the inter- and intra-observer agreement among experienced shoulder surgeons assessing overstuffing, implant positioning, and size following resurfacing hemiarthroplasty using plain standardized radiographs.

Methods

Six experienced shoulder surgeons independently classified implant inclination, size of the implant and if the joint seemed overstuffed, in 219 cases of post-implant radiographs. All cases were classified twice 3 weeks apart. Only radiographs with an anterior-posterior projection with a freely visible joint space were used. Non-weighted Cohen’s kappa values were calculated for each coder pair and the mean used as an estimate of the overall inter-observer agreement.

Results

The overall inter-observer agreement for implant size (kappa, 0.48 and 0.41) and inclination angle was moderate in both rounds (kappa, 0.46 and 0.44), but only a fair agreement was found concerning the evaluation for stuffing of the joint (kappa, 0.24 and 0.28). Intra-observer agreement for implant size and stuffing ranged from fair to substantial while the agreement for inclination was moderate to substantial.

Conclusions

Our results indicate that a visual evaluation of plain radiographs may be inadequate to evaluate overstuffing, implant positioning, and size following resurfacing hemiarthroplasty using plain standardized radiographs. Future studies may contribute to elucidate whether reliability increases if consensus on clear definitions and standardized methods of evaluation is made.

Total shoulder prosthesis with humeral resurfacing: Impact on lateral offset and short-term clinical consequences

BACKGROUND

Reports of early glenoid wear after humeral resurfacing hemiarthroplasty have prompted the use, in combination with this procedure, of newly developed glenoid implants. This combination can increase global humeral offset. The objectives of this study were to assess changes in overall lateral offset and their potential short-term clinical consequences after combined humeral resurfacing and glenoid replacement.

HYPOTHESIS

Combined humeral resurfacing and glenoid replacement induces a large increase in overall lateral offset, resulting in short-term clinical consequences.

MATERIAL AND METHODS

A single-centre prospective study was started in November 2011. Consecutive patients scheduled for total shoulder arthroplasty with humeral resurfacing were included. The primary outcome measure was the change in lateral offset between radiographs obtained pre-operatively and 3 months post-operatively. The functional outcome assessed using the Constant score was compared between the groups with a lateral offset change <10mm vs. ≥10mm.

RESULTS

From November 2011 to November 2014, 35 total shoulder arthroplasties with humeral resurfacing were performed in 32 patients with a mean age of 72.1 years (range, 55-86 years). Mean follow-up was 20±6 months (range, 12-31 months). Overall lateral offset was significantly greater post-operatively than pre-operatively (14±6mm vs. 5±7mm, p<0.0001), the mean difference being 8mm (range, 2-20mm). Post-operative range of motion was better in the group with an overall lateral offset ≥10mm (p=0.0016).

DISCUSSION

Combined humeral resurfacing and glenoid replacement markedly increases overall lateral offset. This increase is not associated with adverse effects on short-term function and may improve post-operative motion range. However, greater lateral offset elevates the loads on the glenoid implant, which may increase the risk of glenoid implant loosening and rotator cuff tearing. Close radiological monitoring is therefore imperative.

LEVEL OF EVIDENCE

IV, prospective cohort study.

Lower age increases the risk of revision for stemmed and resurfacing shoulder hemi arthroplasty

Background and purpose - The number of patients where shoulder hemiarthroplasty (SHA) is an option is still substantial. Descriptive analyses performed by the Swedish Shoulder Arthroplasty Registry (SSAR) showed that while patients receiving SHA designs, i.e. resurfacing hemi (RH) and stemmed hemi (SH), reported similar shoulder functionality and quality of life, the revision rate for RH (12%) was larger than for SH (6.7%); this difference was studied. Patients and methods - All primary SHA (n = 1,140) for OA reported to SSAR between 1999 and 2009 were analyzed regarding risk factors for revision and PROM outcome, 950 shoulders with primary OA (POA), and 190 secondary OA (SOA). Mean age was 67.4 years (SD 10.8). PROM including WOOS and EQ-5D were collected at 5 years, until December 31, 2014. Results - 76/950 prostheses because of POA and 16/190 prosthesis because of SOA were revised. Age at primary surgery was the main factor that influenced the risk of revision, lower age increased the risk of revision, and was also the explanation for the difference between SH and RH. We also found that SH and RH had similar outcomes measured by PROM, but the POA group had higher scores than the SOA group with a clinically relevant difference of 10% in WOOS. Interpretation - The risk of revision for SH and RH is similar when adjusted for age and does not depend on primary diagnosis or sex. A lower age increases the risk of revision. Patients suffering from POA experience better shoulder functionality than SOA patients irrespective of implant type.

Clinical and radiological results 7 years after Copeland shoulder resurfacing arthroplasty in patients with primary glenohumeral osteoarthritis: an independent multicentre retrospective study

PURPOSE

The aim of this multicentre cohort study was to evaluate the midterm outcomes and survival after cementless stemless resurfacing arthroplasty (CSRA) in a series of 33 shoulders in 27 patients with primary osteoarthritis.

METHODS

Clinical outcome assessment included: Constant-Murley score (CMS); Simple Shoulder Test (SST); Disability of Arm, Shoulder, Hand (DASH); EuroQol-5D (EQ-5D) utility scores; Numerous Rating Scale (NRS) for pain. Radiographs were assessed by two independent observers for oversizing, radiolucency, glenohumeral subluxation, glenoid erosion and subsidence. Correlations between the clinical and radiological outcomes were calculated. Complications were registered, and revision and survival rates were calculated.

RESULTS

Mean age at time of surgery and mean follow-up time were, respectively, 67.7 (range 50.2-85.1) and 7.2 years (range 5.7-9.3 years). Means (SD) for CMS, age- and gender-adjusted CMS, SST, DASH and EQ-5D utility scores were: 56.4 (20.2), 76.5 (25.0), 54.0 (29.8), 37.6 (23.3) and 0.8 (0.1), respectively. NRS for pain was 2.0 and 3.8, respectively, in rest and during activities. Radiographic assessment of the CSRAs showed oversizing in 54.5%; radiolucency in 18.2%; superior glenohumeral subluxation in 33.3%; glenoid erosion in 45.5%; and subsidence in 3.0%. Perioperative complications did not occur. Revision surgery was performed in one patient (3.0%).

CONCLUSION

For primary osteoarthritis, the CSRA showed good clinical but poor radiological outcomes at midterm follow-up.

Outcome and revision rate of uncemented glenohumeral resurfacing (C.A.P.) after 5-8 years

BACKGROUND

Resurfacing of the glenohumeral joint for patients with glenohumeral arthritis has gained popularity since the first introduction. We report the mid-term results of the Global C.A.P. uncemented resurfacing shoulder prosthesis (DePuy Synthes).

METHODS

From January 2007 to December 2009, 48 humeral cementless resurfacing prostheses in 46 patients were performed. All patients were diagnosed with primary glenohumeral osteoarthritis. Patients were contacted for review; the Constant Score, visual analog pain scale, Dutch Simple Shoulder Test, SF-12 scores and physical examination were assessed both preoperatively and yearly postoperatively. Complications and revision surgery were documented. Radiographs were evaluated for component size, offset, inclination, height, loosening and subluxation.

RESULTS

Forty-six patients (12 males) with a mean age of 72 years old (range 59-89) were included. At a mean 6.4-year follow-up (range 5-8), the Constant Score, visual analog pain scale and the Dutch Simple Shoulder Test scores improved significantly (p < 0.05) from baseline. Three patients were lost to follow-up. One patient died and two patients were not able to attend the follow-up appointments, due to other health-related issues. Eleven patients (23%) had a revision operation.

CONCLUSIONS

The most important findings of this study of the Global C.A.P. shoulder resurfacing arthroplasty were an increase of range of motion, a reduction of pain complaints, but a concerning high rate of revision after mid-term follow-up.

LEVEL OF EVIDENCE

Therapeutic Level IV.

Radiological and functional 24-month outcomes of resurfacing versus stemmed anatomic total shoulder arthroplasty

PURPOSE

This study compared clinical and radiographic outcomes of patients undergoing resurfacing total shoulder arthroplasty (TSA) with those treated with a stemmed TSA.

METHODS

Patients with primary osteoarthritis who underwent humeral resurfacing (RES) or stemmed (STA) TSA were identified in our shoulder arthroplasty register for retrospective analysis. Standard radiographs and clinical/patient-rated assessments were made up to 24 months post-surgery. Implant revisions were assessed. Patients were frequency-matched in a 1:1 (RES:STA) ratio based on gender and age, and compared with regard to operation time and shoulder function (Constant, SPADI and Quick DASH scores). Mixed models with statistical adjustments were applied.

RESULTS

From 2006 to 2014, 44 RES and 137 STA operations were performed in 157 patients; one and two revisions were recorded in the RES and STA group, respectively. The final matched cohort included a total of 69 patients and 37 operations per treatment group. Resurfacing TSA was 17 min shorter (95%CI: 5-28) compared to the stemmed procedure (p = 0.005). RES and STA patients showed significant functional improvement six months post-implantation, yet all measured scores did not differ between the groups at 2 years (p ≥ 0.131). The status of static centering of the humeral head, acromiohumeral distance, and a lack of signs of implant loosening were also similar between treatments.

CONCLUSION

Similar 24-month post-operative radiological and functional outcome is achieved by RES and STA patients, even with a shorter RES surgery time. Larger cohorts and longer follow-up are required to better assess implant survival.

Long-term follow-up of the Copeland mark III shoulder resurfacing hemi-arthroplasty

BACKGROUND

Shoulder humeral resurfacing is being performed in increasing numbers. We report the long-term outcome of patients with the Copeland mark III humeral resurfacing hemi-arthroplasty.

METHODS

Ninety-five shoulder hemi-arthroplasties were performed in 85 patients, from 1994 to 2003. Oxford Shoulder Score (OSS) and short form 12 (SF-12) questionnaires were administered.

RESULTS

At 12-year follow-up, 49 patients were alive. The OSS was 35.2 and SF-12 score was 83. There were 3 revision operations and 95% survivorship at 18 years.

CONCLUSION

This prosthesis has a low revision rate with few post-operative complications and good patient-reported outcome in an elderly population.

Primary partial humeral head resurfacing: outcomes with the HemiCAP implant

BACKGROUND

Humeral head defects such as degenerative disease or avascular necrosis are often treated with stemmed hemiarthroplasty or total shoulder arthroplasty. Despite its historical and clinical significance, stemmed humeral head replacement poses inherent technical challenges to placing spherical implants at the anatomically correct head height, version, and neck-shaft angle.

PURPOSE

The aim of this study was to assess humeral head inlay arthroplasty as a joint-preserving alternative that maintains the individual head-neck-shaft anatomy. Humeral head inlay arthroplasty also allows intraoperative surface mapping and placement of a contoured articular component that is matched to the patient's defect size, location, and individual surface geometry.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

This retrospective case series included 19 patients (20 shoulders), with an average age of 48.9 years (range, 32-58 years; 16 men, 3 women). Preoperative diagnoses were osteoarthritis in 16 shoulders and osteonecrosis in 4 shoulders. Pre- and postoperative evaluations included physical examination, radiographic assessment, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, the Simple Shoulder Test, a pain visual analog scale, and patient satisfaction rating.

RESULTS

The mean follow-up period was 32.7 months (range, 17-66 months). The mean American Shoulder and Elbow Surgeons score improved from 24.1 to 78.8, mean Simple Shoulder Test score from 3.95 to 9.3, mean visual analog scale score from 8.2 to 2.1, mean forward flexion from 100° to 129°, and mean external rotation from 23° to 43° (P < .001 for all). Radiographic follow-up showed no evidence of periprosthetic fracture, component loosening, osteolysis, or device failure. Patient shoulder self-assessment was 90% poor before surgery and improved to 75% good to excellent at last follow-up; 20% of patients self-rated as somewhat good to somewhat poor, and 5% self-rated as poor. Ninety percent of patients were satisfied with the choice of the procedure. Three patients had postoperative complications unrelated to the implants, including a partial rotator cuff tear treated with physical therapy, preexisting glenoid wear treated with arthroscopic debridement and microfracture, and infection complicated by subscapularis rupture requiring several subsequent surgical procedures but with retention of the implant.

CONCLUSION

Humeral head inlay arthroplasty is effective in providing pain relief, functional improvement, and patient satisfaction. Rather than delaying shoulder arthroplasty to end-stage osteoarthritis, humeral head inlay arthroplasty is a promising new direction in primary shoulder arthroplasty for younger and active patients with earlier stage disease.

Shoulder arthroplasty options in young (<50 years old) patients: review of current concepts

BACKGROUND

Prosthetic shoulder arthroplasty provides excellent pain relief and functional restoration for patients with glenohumeral arthritis, but concerns of survivorship have limited its use in younger patients.

DISCUSSION

Despite general reports of high long-term survivorship, implant failure and functional deterioration after total shoulder arthroplasty are major concerns in the management of younger patients. In addition to having a longer life expectancy, younger patients also tend to be more active and can be expected to place greater demands on their shoulder arthroplasty.

CONCLUSION

Alternative strategies have been developed and used for shoulder arthroplasty in younger patients. This manuscript reviews current concepts of shoulder arthroplasty in young patients.

Stemmed versus stemless total shoulder arthroplasty: a preliminary report and short-term results

BACKGROUND

Although several studies have been performed on the use of various devices in total shoulder arthroplasty (TSA), no data are available in order to establish whether to prefer stemmed or stemless humeral components. Thus, the purpose of our study was to evaluate the short-term functional outcome in a cohort of subjects treated with TSA randomized to treatment with stemmed or stemless prosthesis.

METHODS

In this prospective longitudinal study, we randomized to treatment with stemmed (group 1) or with stemless (group 2) humeral component in nineteen subjects (2 M and 17 F) diagnosed with humeral primary osteoarthritis with indication to TSA. We evaluated the range of movement of all the participants and the functional outcome using Constant score and simple shoulder test (SST) before and after 2 years from surgery.

RESULTS

No differences were detected after 2 years from surgery in the two groups in terms of functional scores and range of motion (p > 0.05).

CONCLUSION

Stemmed and stemless prostheses are comparable in terms of functional outcome. These data might be useful for the surgeon in order to choose more tissues-paring methodologies and less invasive procedures, such as stemless humeral implants.

Evaluation of periprosthetic bone mineral density and postoperative migration of humeral head resurfacing implants: two-year results of a randomized controlled clinical trial

BACKGROUND

Implant migration, bone mineral density (BMD), length of glenohumeral offset (LGHO), and clinical results were compared for the Copeland (Biomet Inc, Warsaw, IN, USA) and the Global C.A.P. (DePuy Int, Warsaw, IN, USA) humeral head resurfacing implants (HHRIs).

METHODS

The study randomly allocated 32 patients (13 women), mean age 63 years (range, 39-82 years), with shoulder osteoarthritis to a Copeland (n = 14) or Global C.A.P. (n = 18) HHRI. Patients were monitored for 2 years with radiostereometry, dual-energy X-ray absorptiometry, Constant Shoulder Score (CSS), and the Western Ontario Osteoarthritis of the Shoulder Index (WOOS). LGHO was measured preoperatively and 6 months postoperatively.

RESULTS

At 2 years, total translation (TT) was 0.48 mm (standard deviation [SD], 0.21 mm) for the Copeland and 0.82 mm (SD, 0.46 mm) for the Global C.A.P. (P = .06). Five HHRI were revised, and in the interval before the last follow-up (revision or 2 years), TT of 0.58 mm (SD, 0.61 mm) for revised HHRI was higher (P = .02) than TT of 0.22 mm (SD, 0.17 mm) in nonrevised HHRI. A comparison of TT at the last follow-up (revision or 2 years) found no difference between the HHRIs (P = .12). Periprosthetic BMD decreased initially but increased continuously after 6 months for both HHRIs. At 2 years, BMD was 48% higher around the Copeland HHRI (P = .005). The mean difference in LGHO was significantly higher for the Copeland than for the Global C.A.P. HHRI (P = .02). Clinical results evaluated with CSS and WOOS improved over time for both implant groups (P < .01), with no differences between the groups.

CONCLUSION

Both implants had only little migration and good clinical results. Periprosthetic BMD and LGHO both increased for the Copeland HHRI more than for the Global C.A.P HHRI.

Results of cementless humeral head resurfacing with cemented glenoid components

PURPOSE

The aim of this study was to analyse the short- and medium-term clinical and radiographic results of cementless humeral head resurfacing in combination with a cemented glenoid component.

METHODS

Thirty-five patients with a mean age of 65 years (range 42-84) and a mean follow-up of three years (two to six) were followed up. The Constant score with its subgroups as well as shoulder motions and complications were recorded. Radiographs in two planes were analysed for loosening of the components.

RESULTS

Mean Constant score improved from 29 points (6-63) to 70 points (41-89; p < 0.001). Mean shoulder flexion increased from 89° (20-170) to 158° (100-180) and mean external rotation from 10° (-10-30) to 39° (10-80). Satisfaction rate was 94 % at final follow-up. None of the components was found to be loose. There were three neurological complications, probably related to increased forces on the humeral head retractor during glenoid preparation. Two of them resolved completely; in one patient hyposensitivity remained.

CONCLUSION

Cementless humeral surface replacement arthroplasty in combination with a cemented glenoid component leads to an overall satisfactory clinical outcome. However, the high rate of neurological complications found in this study, probably related to difficult glenoid exposure, led us to discontinue this implant configuration.

Resurfacing hemiarthroplasty compared to stemmed hemiarthroplasty for glenohumeral osteoarthritis: a randomised clinical trial

PURPOSE

The aim of this study was to conduct a randomised, clinical trial comparing stemmed hemiarthroplasty and resurfacing hemiarthroplasty in the treatment of glenohumeral osteoarthritis.

METHODS

A total of 40 shoulders (35 patients) were randomised to stemmed hemiarthroplasty or resurfacing hemiarthroplasty and evaluated three and 12 months postoperatively using the Constant-Murley score (CMS) and Western Ontario Osteoarthritis of the Shoulder (WOOS) index.

RESULTS

There were no statistically significant differences in age, gender or pre-operative scores except for WOOS at baseline. Two patients were lost to follow-up. Significant improvements in CMS and WOOS were observed at one year after both arthroplasty designs. At one year, the mean CMS was 48.9 (range 6-80) after resurfacing hemiarthroplasty and 59.1 (range 0-88) after stemmed hemiarthroplasty {mean difference 10.2 [95 % confidence interval (CI) -3.3 to 23.6], P = 0.14}. The mean WOOS was 59.2 (range 5.2-100.0) and 79.4 (range 12.8-98.6), respectively [mean difference 20.2 (95 % CI 3.4-36.9), P = 0.02]. No major complications occurred and there were no revisions.

CONCLUSIONS

The effects of resurfacing hemiarthroplasty tended to be inferior to those of stemmed hemiarthroplasty. It is unclear whether this reflects a real difference in effect or baseline differences due to the limited number of randomised patients. We suggest there is a need for a larger, more definitive trial.

Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder: 837 operations reported to the Danish Shoulder Arthroplasty Registry

In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7.5%) required revision; the cumulative five-year rate of revision was 9.9%. Patients aged < 55 years had a statistically significant inferior WOOS score, which exceeded the minimal clinically important difference, compared with older patients (mean difference 14.2 (8.8; 95% CI 19.6; p < 0.001), but with no increased risk of revision. There was no significant difference in the mean WOOS or the risk of revision between designs of resurfacing hemiarthroplasty.

Outcome and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis

This thesis includes four studies focusing on the functional outcome, shoulder-specific quality of life and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis without symptomatic rotator cuff pathology. The Danish version of WOOS, translated according to international standardized guidelines, had substantial psychometric properties comparable to the original version. It is recommendable to use WOOS in the evaluation of patients with glenohumeral osteoarthritis treated with shoulder replacement. Data from DSR showed that the shoulder specific quality of life following total shoulder arthroplasty was superior to that of hemiarthroplasty (resurfacing hemiarthroplasty and stemmed hemiarthroplasty). The difference between stemmed hemiarthroplasty and resurfacing hemiarthroplasty was small and did not exceed the minimal clinically important difference. The revision rate following resurfacing hemiarthroplasty was surprisingly high compared with previous reports but there were no statistical significant differences in revision rate between arthroplasty designs. The shoulder specific quality of life and revision rate in patients under the age of 55 was worrying. The use of resurfacing hemiarthroplasty has relied on the results from case series only. The efficacy in the treatment of glenohumeral osteoarthritis has been promising but the CMS found in the randomized clinical trial indicate that the functional outcome may be inferior to that of stemmed hemiarthroplasty and less favourable than previously reported. However, the limited number of patients may have influenced the results and a larger definitive RCT is needed.Shoulder replacement is relevant and effective in the treatment of glenohumeral osteoarthritis; however, resurfacing hemiarthroplasty was associated with a poorer outcome and a higher risk of revision than previously assumed especially in patients under the age of 55. Based on data from this thesis, and based on existing knowledge, it seems like total shoulder arthroplasty should be preferred in the treatment of glenohumeral osteoarthritis. Shoulder replacement is rarely indicated in younger patients where other treatment options (e.g., physiotherapy; intraarticular injections of hyaluronate; and joint preserving surgery) should be considered until the efficacy of shoulder replacement has been more thoroughly documented.

Patient-reported outcome and risk of revision after shoulder replacement for osteoarthritis. 1,209 cases from the Danish Shoulder Arthroplasty Registry, 2006-2010

PURPOSE

We used patient-reported outcome and risk of revision to compare hemiarthroplasty (HA) with total shoulder arthroplasty (TSA) and stemmed hemiarthroplasty (SHA) with resurfacing hemiarthroplasty (RHA) in patients with glenohumeral osteoarthritis.

PATIENTS AND METHODS

We included all patients reported to the Danish Shoulder Arthroplasty Registry (DSR) between January 2006 and December 2010. 1,209 arthroplasties in 1,109 patients were eligible. Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome 1 year postoperatively. For simplicity of presentation, the raw scores were converted to a percentage of the maximum score. Revision rates were calculated by checking reported revisions to the DSR until December 2011. WOOS and risk of revision were adjusted for age, sex, previous surgery, and type of osteoarthritis.

RESULTS

There were 113 TSAs and 1096 HAs (837 RHAs and 259 SHAs). Patients treated with TSA generally had a better WOOS, exceeding the predefined minimal clinically important difference, at 1 year (mean difference 10, p < 0.001). RHA had a better WOOS than SHA (mean difference 5, p = 0.02), but the difference did not exceed the minimal clinically important difference. There were no statistically significant differences in revision rate or in adjusted risk of revision between any of the groups.

INTERPRETATION

Our results are in accordance with the results from other national shoulder registries and the results published in systematic reviews favoring TSA in the treatment of glenohumeral osteoarthritis. Nonetheless, this registry study had certain limitations and the results should be interpreted carefully.

Surface Replacement Arthroplasty of the Humeral Head in Young, Active Patients: Midterm Results

Background:

The treatment of glenohumeral arthritis in young, active patients remains controversial. Standard total shoulder arthroplasty in this patient group has not obtained the same satisfaction rate as in older patients. One surgical option that has emerged is humeral resurfacing.

Hypothesis:

Humeral head surface replacement arthroplasty (SRA) would provide satisfactory clinical outcomes in active patients, allowing them to maintain their normal lifestyle without activity restrictions.

Study Design:

Case series; Level of evidence, 4.

Methods:

From 2004 to 2007, all consecutive surface replacement arthroplasties of the humerus performed at the authors’ institution were identified and retrospectively reviewed, and 118 patients who underwent SRA during this time were identified. This study included patients younger than 60 years who wished to maintain an active lifestyle; 52 of the 118 patients met the inclusion criteria. University of California at Los Angeles (UCLA) shoulder scores and subjective shoulder value (SSV) scores were used to measure clinical outcomes at an average follow-up of 6 years (range, 4-8 years). Of the 52 patients meeting the inclusion criteria, 48 were contacted and examined for the study, with 4 patients lost to follow-up.

Results:

The mean postoperative UCLA score was 28.03, with 1 patient requiring revision because of pain and glenoid wear. The mean SSV was 92% (range, 0%-100%), with 3 patients restricting their activity because of the shoulder. Forty-seven of the 48 contacted patients stated that, given the option, they would have the same surgery again. One patient required revision surgery because of pain.

Conclusion:

Surface replacement arthroplasty provided reasonable results in patients younger than 60 years with high activity demands with a low rate of revision at midterm follow-up.

Short-term results of the global C.A.P. uncemented resurfacing shoulder prosthesis

The authors report the 2-year results of an uncemented resurfacing shoulder prosthesis in 47 patients with primary glenohumeral osteoarthritis who underwent a cementless humeral resurfacing arthroplasty between 2007 and 2009. Constant scores (corrected for sex and age), shoulder function, visual analog pain scales, Dutch Simple Shoulder Tests, and physical SF-12 scores improved significantly (P<.05) from preoperatively to 2 years postoperatively. Mental SF-12 scores remained the same. Complications included 1 traumatic lesser tuberosity avulsion fracture, 1 intra-articular loose body due to a fractured osteophyte, and 1 subscapularis tendon rupture. No patient required revision surgery for any reason. Cementless humeral resurfacing arthroplasty is a viable treatment option for primary glenohumeral arthritis.

Humeral surface replacement for osteoarthritis

BACKGROUND AND PURPOSE

Humeral resurfacing has shown promising results for osteoarthritis, but revisions for glenoid erosion have been reported frequently. We investigated the hypothesis that preoperative glenoid wear and postoperative progress of glenoid erosion would influence the clinical outcome.

METHODS

We reviewed 61 resurfacing hemiarthroplasties (55 patients) for primary osteoarthritis. 6 patients were lost to follow-up and 5 had undergone revision arthroplasty. This left 50 shoulders in 44 patients (mean age 66 years) that were followed for mean 30 (12-44) months. Complications, revisions, and the age- and sex-related Constant score were assessed. Radiographs were evaluated for loosening and glenoid erosion according to Walch.

RESULTS

Of the 50 shoulders that were functionally assessed, the average age- and sex-related Constant score was 73%. In patients with preoperative type-B2 glenoids, at 49% it was lower than in type-A1 glenoids (81%, p = 0.03) and in type-B1 glenoids (84%, p = 0.02). The average age- and sex-related Constant score for patients with type-A2 glenoids (60%) was lower than for type-A1 and -B1 glenoids and higher than for type-B2 glenoids, but the differences were not statistically significant. In the total population of 61 shoulders, the radiographs showed postoperative glenoid erosion in 38 cases and no humeral prosthetic loosening. Revision arthroplasty was performed in 11 cases after 28 (7-69) months. The implant size had no statistically significant influence on the functional outcome. The size was considered to be adequate in 28 of the 50 functionally assessed shoulders. In 21 cases, the implant size was too large and in 1 case it was too small.

INTERPRETATION

We found frequent postoperative glenoid erosion and a high rate of revision arthroplasty after humeral resurfacing for primary osteoarthritis. Oversizing of the implants was common, but it had no statistically significant influence on the functional outcome. Inferior results were found in the presence of increased eccentric preoperative glenoid wear. Total shoulder arthroplasty should be considered in these patients.

Outcome of Copeland shoulder resurfacing arthroplasty with a 4-year mean follow-up

BACKGROUND

Published data on the outcome of Copeland shoulder resurfacing arthroplasty (CSRA) are limited. This observational case series study reports the functional and radiological outcome of CSRA during a mean follow-up of 4 years and highlights the correlation between key outcome measures.

METHODS

One-hundred two consecutive patients with osteoarthritis (OA-47.1%), rheumatoid arthritis (RA-40.2%), rotator cuff arthropathy (RCA-8.8%), and avascular necrosis (AVN-3.9%) underwent CSRA. The outcome assessment included pain and satisfaction, physical limitation, Oxford Shoulder score (OSS), Constant score (CS), and SF-12. Imaging was reviewed for glenoid morphology (Walch classification) and humeral head (HH) migration.

RESULTS

Highest patient satisfaction and lowest pain levels were related to the primary pathology with AVN best followed by OA, RA, and with RCA having the poorest outcome. Comparing the two largest groups the CS was significantly higher in OA (61 ± 21.3) than RA (44 ± 20.5). OSS showed a significant correlation with CS and physical subscale of SF-12. Walch type A (67.6%) and HH migration (47%) were the commonest radiographic observations. OSS, CS, pain, and satisfaction were significantly different between migration and nonmigration groups.

CONCLUSION

The CSRA resulted in satisfactory outcome in many patients. AVN and OA were associated with the best and RCA with the poorest results. The CSRA was associated with glenoid erosion and HH migration particularly in RCA. CSRA remains an option in the treatment of arthritic conditions of the shoulder but its future use may be limited to younger patients where implanting a glenoid may be regarded as problematic.

The use of shoulder hemiarthroplasty and humeral head resurfacing: a review of current concepts

Since Neer's early work in the 1950s shoulder arthroplasty has evolved as a treatment option for various glenohumeral joint disorders. Both hemiarthroplasty and total shoulder prostheses have associated problems. This has led to further work with regards to potential resurfacing, with the aim of accurately restoring native proximal humeral anatomy while preserving bone stock for later procedures if required. Hemiarthroplasty remains a valuable treatment option in the low demand patient or in the trauma setting. Additional work is required to further define the role of humeral resurfacing, with the potential for it to become the gold standard for younger patients with isolated humeral head arthritis.

Thermal damage during humeral reaming in total shoulder resurfacing

INTRODUCTION

Total shoulder resurfacing (TSR) provides a reliable solution for the treatment of glenohumeral arthritis. It confers a number of advantages over traditional joint replacement with stemmed humeral components, in terms of bone preservation and improved joint kinematics. This study aimed to determine if humeral reaming instruments produce a thermal insult to subchondral bone during TSR.

PATIENTS AND METHODS

This was tested in vivo on 13 patients (8 with rheumatoid arthritis and 5 with osteoarthritis) with a single reaming system and in vitro with three different humeral reaming systems on saw bone models. Real-time infrared thermal video imaging was used to assess the temperatures generated.

RESULTS

Synthes (Epoca) instruments generated average temperatures of 40.7°C (SD 0.9°C) in the rheumatoid group and 56.5°C (SD 0.87°C) in the osteoarthritis group (P = 0.001). Irrigation with room temperature saline cooled the humeral head to 30°C (SD 1.2°C). Saw bone analysis generated temperatures of 58.2°C (SD 0.79°C) in the Synthes (Epoca) 59.9°C (SD 0.81°C) in Biomet (Copeland) and 58.4°C (SD 0.88°C) in the Depuy Conservative Anatomic Prosthesis (CAP) reamers (P = 0.12).

CONCLUSION

Humeral reaming with power driven instruments generates considerable temperatures both in vivo and in vitro. This paper demonstrates that a significant thermal effect beyond the 47°C threshold needed to induce osteonecrosis is observed with humeral reamers, with little variation seen between manufacturers. Irrigation with room temperature saline cools the reamed bone to physiological levels and should be performed regularly during this step in TSR.

Aequalis humeral head resurfacing in glenohumeral arthritis at a minimum followup of 2 years

Aim. To evaluate results of Aequalis humeral head resurfacing in patients with end-stage glenohumeral arthritis at a minimum followup of two years. Patients and Methods. Twenty-one consecutive patients underwent humeral head resurfacing hemiarthroplasty between 2007 and 2009. Three patients did not fulfill the inclusion criteria. 18 patients with mean age of 75.1 years (range 58-91 years) and a mean duration of preoperative symptoms of 33.6 months (range 6-120 months) were analyzed. Patients' self-reported Oxford shoulder score (OSS) was collected prospectively and was used as an assessment tool to measure final outcome. Results. The mean initial OSS was 15 (range 3-29). The score improved by an average of 19.5 points at a mean followup of 36.3 months (range 24-54 months) to reach a mean final OSS of 34.5 (range 6-47). The improvement of OSS was highly significant with a two-tailed P value less than 0.0001. The overall patient satisfaction was 94%. Conclusion. This study demonstrates Aequalis shoulder resurfacing hemiarthroplasty as a reliable procedure, away from its originating center, for improvement of shoulder function as shown by the patients' self-reported outcome score (OSS) in end-stage glenohumeral arthritis at a minimum followup of 2 years.

Shoulder and elbow arthroplasty in younger patients

Joint arthroplasty is common in elderly patients with arthritis. The success of joint arthroplasty in the elderly population has increased the indications for joint arthroplasty in younger patients. The success and increased indications are due to advances in technology and joint arthroplasty design and materials, as well as to bone-conserving approaches that are more applicable to younger patients. Although most joint arthroplasty procedures are for the hip and knee, the upper extremity (shoulder and elbow) is the fastest-growing segment of joint arthroplasty procedures. This article presents innovative approaches to shoulder and elbow arthroplasty that are designed to treat younger patients with arthritis of the shoulder and elbow.

Precision of novel radiological methods in relation to resurfacing humeral head implants: assessment by radiostereometric analysis, DXA, and geometrical analysis

BACKGROUND

Resurfacing humeral head implants (RHHI) are used to preserve bone stock and restore normal anatomy in the osteoarthritic shoulder joint. The purpose of this study was: (1) to describe the use of novel radiological methods in relation to evaluation of RHHI; (2) to estimate the precision of these methods; and (3) to present preliminary clinical and radiological results at 6 months follow-up after Copeland and Global Cap RHHI.

METHODS

Twenty-one patients (10 females) at a mean age of 64 (39-82) years and with shoulder osteoarthritis were randomized to a Copeland (n = 11) or Global C.A.P (n = 10) RHHI. Migration of the RHHI was analyzed with radiostereometric analysis (RSA), and bone mineral density (BMD) was measured with dual energy X-ray absorptiometry (DXA). The length of gleno-humeral offset (LGHO) was measured on radiographs. The patients were followed clinically with questionnaires.

RESULTS

Precision of the radiological methods was high for the LGHO and acceptable for RSA and for DXA. At 6 months, shoulder function had improved significantly for both RHHI groups. LGHO increased significantly for the Copeland RHHI and was slightly reduced for the Global C.A.P. RHHI. The implant migration and BMD change around the implant from baseline until 6 months follow-up was comparable for both RHHI.

CONCLUSION

Radiostereometric analysis and DXA can be used for evaluation of RHHI, but expectedly with a lower precision as compared to standards of TKA or THA. Geometric analysis of the prosthetic shoulder is precise. We interpret that the early radiological and clinical results of the two RHHI are comparable.