6-Year clinical results and survival of Copeland Resurfacing hemiarthroplasty of the shoulder in a consecutive series of 279 cases

BACKGROUND

Medium-term clinical results and survival of the Copeland resurfacing hemiarthroplasty of the shoulder (CRHA) in a large consecutive group are presented with a comparison of outcomes for underlying pathologies.

METHODS

A consecutive series of patients undergoing CRHA over 14 years was retrospectively analysed with no exclusions. Patients had a minimum 2-year follow-up by an independent assessor. Functional outcome was assessed using the Oxford Shoulder Score (OSS) and Constant-Murley Score (CMS). Pain and satisfaction was assessed using a visual analogue score.

RESULTS

279 CRHAs were performed in 242 patients between 2002 and 2016. The mean follow-up was 6 years. The indication for surgery was osteoarthritis (OA) in 212, inflammatory arthropathy (RA) in 35, rotator cuff tear arthropathy (CTA) in 22 and avascular necrosis (AVN) in 2. For the OA group, 5-year survival was 90%, 10-year survival was 83% and mean survival was 13.2 years (95% CI 12.5-13.9). The mean OSS was 35.0 and mean CMS 49.9. CRHA for CTA had significantly poorer (p < 0.001) 5-year survival (55%), 10-year survival (41%) and mean survival (5.9 years, 95% CI 4.7-7.2). Mean OSS was 23.6 and mean CMS 30.3, which was poorer than for OA (p < 0.001). A subgroup analysis of OA patients found significantly better survival (p = 0.013) in those aged over 65 years but no difference in functional outcome.

CONCLUSION

CRHA remains a reasonable option for OA in patients with an intact rotator cuff and with sufficient bone stock, especially in those aged over 65 years. With poorer functional outcomes and survival, CRHA should not be offered in those with CTA.

LEVEL OF EVIDENCE

Level III (retrospective comparative study).

Comparative study of total shoulder arthroplasty versus total shoulder surface replacement for glenohumeral osteoarthritis with minimum 2-year follow-up

BACKGROUND

Compared with total shoulder arthroplasty (TSA), total shoulder surface replacement (TSSR) may offer the advantage of preservation of bone stock and shorter surgical time, possibly at the expense of glenoid component positioning and increasing lateral glenohumeral offset. We hypothesized that in patients treated for osteoarthritis with a sufficient rotator cuff, TSA and TSSR patients have comparable functional outcome, glenoid component version, and lateral glenohumeral offset.

METHODS

We conducted a retrospective cohort study with a minimum of 2 years of follow-up. Patients in the TSA and TSSR groups received a cemented, curved, keeled, all-poly glenoid component. A cemented anatomical humeral stem was used in TSA. TSSR involved a humeral surface replacement (all components from Tornier Inc., St Ismier, France). Patients were assessed for functional outcome. Radiographs were assessed for radiolucent lines. Glenoid component position and lateral glenohumeral offset were assessed using computed tomography images.

RESULTS

After 29 and 34 months of mean follow-up, respectively, TSA (n = 29) and TSSR (n = 20) groups showed similar median adjusted Constant Scores (84% vs. 88%), Oxford Shoulder Scores (44 vs. 44), Disabilities of the Arm, Shoulder and Hand scores (22 vs. 15), and Dutch Simple Shoulder Test scores (10 vs. 11). Glenoid components showed similar radiolucent line counts (median, 0 vs. 0), similar anteversion angles (mean, 0° vs. 2°), and similar preoperative to postoperative increases in lateral glenohumeral offset (mean, 4 vs. 5 mm). One intraoperative glenoid fracture occurred in the TSSR group.

CONCLUSION

Short-term functional and radiographic outcomes were comparable for TSA and TSSR.

Cementless surface replacement hemiarthroplasty for primary glenohumeral osteoarthritis: results of over 5-year follow-up in patients with or without rotator cuff deficiency

BACKGROUND

Cementless surface replacement hemiarthroplasty (CSRHA) is an established treatment for glenohumeral osteoarthritis; however, studies evaluating its role in arthritis with rotator cuff deficiency are limited. This study reviews the outcomes of CSRHA for glenohumeral osteoarthritis with and without rotator cuff tears.

METHODS

41 CSRHA (Mark III Copeland prosthesis) were performed for glenohumeral osteoarthritis with intact rotator cuffs (n = 21) and cuff-deficient shoulders (n = 20). Patients were assessed using Oxford and Constant questionnaires, patient satisfaction, range of motion measurements and by radiography.

RESULTS

Mean age and follow-up were 75 years and 5.1 years, respectively. Functional gains were significantly higher in patients with intact rotator cuffs compared to cuff-deficient shoulders, with Oxford Shoulder Score improving from 18 to 37.5 and 15 to 27 and forward flexion improved from 60° to 126° and 44° to 77° in each group, respectively. Two patients with deficient cuffs had deficient subscapularis tendons; one of which was dislocated anteriorly.

CONCLUSIONS

CSRHA provides significant improvements in pain and function in patients with glenohumeral osteoarthritis. In patients with deficient cuffs, functional gains are limited, and should be considered in low-demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis as a result of the risk of dislocation.

Cementless surface replacement arthroplasty of the shoulder for osteoarthritis: results of fifty Mark III Copeland prosthesis from an independent center with four-year mean follow-up

PURPOSE

Few studies have reported the outcome of cementless surface replacement (CSRA). We initiated this study to analyze results of the Mark III Copeland prosthesis used as a hemiarthroplasty in patients with glenohumeral osteoarthritis.

MATERIALS AND METHODS

We retrospectively reviewed 53 consecutive Mark III Copeland CRSA hemiarthroplasties in 46 patients (30 women, 16 men) with glenohumeral osteoarthritis from an independent institution by a single surgeon. Patients were a mean age of 69 years (range, 45-94 years). Mean follow-up was 4.2 years (range, 2-8 years). Fifty uncemented hemiarthroplasties were available for review.

RESULTS

Mean (range) age-adjusted Constant and Oxford scores improved from 38.5 (15-61) and 22 (9-31) to 75.1 (38-87) and 42 (18-48), respectively. Anterosuperior escape of the humeral head developed in 1 patient who had an oversized humeral component due to progressive rotator cuff failure at 2 years. Moderate glenoid erosion was present in 12% and correlated with oversizing of the humeral component. There was one revision to a stemmed cemented hemiarthroplasty for periprosthetic fracture. No patients have required revision for aseptic loosening, rotator cuff failure, or glenoid erosion to date.

CONCLUSIONS

Copeland surface replacement hemiarthroplasty for glenohumeral osteoarthritis can provide functional results similar to modular stemmed prostheses, with a relatively low revision rate at 4.2 years of follow-up; however, there is high rate of glenoid erosion that may complicate future revision surgery, and we did not achieve the same functional improvement as that achieved from the designer's institution.

Humeral head resurfacing in central bone defects: in vitro stability of different implants with increasing defect size

We examined the rotary motions of two distinct cementless surface replacement arthroplasties of the shoulder that were implanted on humeri with central spherical bone defects of 8%, 17%, and 37% of the head volume (n = 5 each). Rotary motions were measured under a cyclic torque application and translated into relative micromotions. Implant A with a perforated central crown had micromotions < 150 µm in all bony defects and during all simulated shoulder activities. Implant B with a central tapered tri-fin pin had no micromotions > 150 µm in defects of 0% and 8% during a strenuous activity like lifting 10 kg, but did exhibit micromotion > 150 µm in 40% of the experiments in defects of 17% and 37%, which could impair bony ingrowth. Implant B displayed a significant increase in micromotions for defects of 8% and 17% (p < 0.05). Our results suggest that implant A could be used without risk in spherical head defects up to 37% of volume, even in strenuous shoulder activities immediately after its implantation. Implant B, however, is recommended in spherical defects starting from 8% and only during light shoulder activities until bony integration of the implant has occurred.

Comparison of the short-term functional results after surface replacement and total shoulder arthroplasty for osteoarthritis of the shoulder: a matched-pair analysis

INTRODUCTION AND PURPOSE

The purpose of this clinical study with a matched-pair design was to compare the functional short-term results obtained in patients with primary osteoarthritis of the shoulder treated with cementless surface replacement of the humeral head (CUP) with those obtained after total shoulder replacement (TSR).

MATERIALS AND METHODS

Twenty-two patients (average age 61.4 years; 11 men, 11 women) with primary osteoarthritis who obtained surface replacement of the humeral head were matched to a control group of 22 patients (average age 61.1 years, 11 men, 11 women) with the same in- and exclusion criteria that were treated with a total shoulder arthroplasty. Preoperative status, perioperative results and postoperative status (Constant score and subcategories, subjective status, range of motion, radiographic evaluation) were compared in all patients and controls. Non-parametric analyses were used to compare the results in both groups.

RESULTS

Patients in the CUP group showed significantly better perioperative results (time of surgery, blood loss, days of inpatient treatment) compared to the patients in the TSR group. Results at 6 and 12 months revealed significant improvement of clinical function, significant pain reduction, and high subjective satisfaction rates in both groups. Concerning the absolute values, there were tendencially better results obtained in the TSR group compared to the CUP group at 12 months follow-up (Constant score 67.23 +/- 11.71 vs. 59.25 +/- 14.53), but only the criteria "mobility" and "abduction" revealed statistical significance. Regarding the relative improvement at 12 months compared to the baseline status, patients treated with TSR showed a significant better benefit in the total Constant score (+41.32 +/- 0.04 vs. +26.16 +/- 8.82) and in range of motion. Regarding the subjective assessment, there was no statistically significant difference in patients with TSR (mean value 1,5 (+/-0.55)) and patients with CUP (mean value 2,3 (+/-0.92)). Two CUP implants had to be removed during the follow-up period owing to secondary glenoidal erosion.

CONCLUSIONS

At short-term follow-up, surface replacement as a technically less demanding technique provided only slightly inferior results to TSR. We therefore believe that CUP arthroplasty is a therapeutic option and can be recommended in patients with primary osteoarthritis when limited to strictly defined indications.

Outcome of Copeland surface replacement shoulder arthroplasty

We report the outcome of humeral head surface replacement hemiarthroplasty performed at our institution using the Copeland prosthesis. We followed 56 shoulders (52 patients) for a mean of 34.2 months (range, 24-63 months). Two were lost to follow-up, and there were six deaths unrelated to the shoulder surgery. Preoperative diagnoses in the remainder were osteoarthritis (20), rheumatoid arthritis (26), rotator cuff tear arthropathy (1), and post-traumatic arthrosis (1). The mean age was 68 years. Constant scores for the whole group improved from a mean preoperative score of 16.4 (range, 8-36) to 54.0 (range, 20-83) at last follow-up (P < .05). Three cases underwent subsequent arthroscopic subacromial decompression for impingement symptoms. One case required revision for aseptic loosening to a stemmed implant. Contained, nonprogressive osteolysis was seen in 2 cases. One periprosthetic humeral neck fracture was managed successfully nonoperatively. These results are comparable to those obtained with a modern stemmed hemiarthroplasty and are similar to Copeland's own series.