There is major controversy surrounding the use of hemiarthroplasty as compared with total shoulder arthroplasty for glenohumeral osteoarthritis, and long-term clinical outcomes of hemiarthroplasty are lacking.
Methods
Of a cohort of 30 patients (31 shoulders) who were treated with hemiarthroplasty for glenohumeral osteoarthritis and followed longitudinally at our institution, 25 were available for long-term follow-up; 5 died, and one refused to participate.
3 of the 5 patients who died had revision arthroplasty before death, and the data from those 3 were therefore included in the final follow-up (final follow-up data therefore included 27 patients and 28 shoulders).
Follow-up through phone conversations and postal mail surveys included the following: Short Form-36, American Shoulder and Elbow Surgeons (ASES) shoulder outcome score, EuroQol, Simple Shoulder Test, modified Neer Score, and a unique, validated self-administered range-of-motion questionnaire.
Correlations between clinical outcome and age, type of glenoid wear, and cause of osteoarthritis were determined.
Results
The average follow-up was 17.2 years (range, 13 to 21 years).
There were 8 revisions (3 of 15 shoulders with concentric glenoids, and 5 of 16 shoulders with eccentric glenoids).
For those shoulders not revised, the average ASES score was 70.54 (range, 36.67 to 91.67).
Overall, active shoulder forward elevation and external rotation with the arm at 90° of abduction increased from 104° preoperatively to 141.8° (range, 45° to 180°) and 20.7° to 61.0° (range, 30° to 90°), respectively (p < 0.05), at the time of final follow-up.
Of those who required revision arthroplasty, the average patient age at the time of the index procedure was 51.0 years (range, 26 to 81 years), while those not requiring revision averaged 57.1 years (range, 27 to 63 years).
The overall Neer satisfaction rating was 25%.
The average Neer score and Neer rating for unrevised cases were significantly higher for concentric glenoid wear compared with eccentric glenoid wear (p = 0.015 and p = 0.001, respectively).
Patients who had concentric glenoid wear had higher EuroQol scores (p = 0.020).
The average Neer scores were 65.29 (range, 47 to 78) for primary osteoarthritis and 54.46 (range, 40 to 77) for secondary osteoarthritis (p = 0.036).
Conclusions
Only 25% of patients with glenohumeral osteoarthritis treated with shoulder hemiarthroplasty are satisfied with their outcome at an average of 17 years after the operation. Patients with concentric glenoid wear and primary osteoarthritis have better outcomes than those with eccentric glenoid wear and secondary osteoarthritis do, but patients in both groups experienced deterioration of results over time.
Level of evidence: Therapeutic Level IV. Copyright remains with the authors and publisher.
There is major controversy surrounding the use of hemiarthroplasty as compared with total shoulder arthroplasty for glenohumeral osteoarthritis, and long-term clinical outcomes of hemiarthroplasty are lacking.
Methods
Of a cohort of 30 patients (31 shoulders) who were treated with hemiarthroplasty for glenohumeral osteoarthritis and followed longitudinally at our institution, 25 were available for long-term follow-up; 5 died, and one refused to participate.
3 of the 5 patients who died had revision arthroplasty before death, and the data from those 3 were therefore included in the final follow-up (final follow-up data therefore included 27 patients and 28 shoulders).
Follow-up through phone conversations and postal mail surveys included the following: Short Form-36, American Shoulder and Elbow Surgeons (ASES) shoulder outcome score, EuroQol, Simple Shoulder Test, modified Neer Score, and a unique, validated self-administered range-of-motion questionnaire.
Correlations between clinical outcome and age, type of glenoid wear, and cause of osteoarthritis were determined.
Results
The average follow-up was 17.2 years (range, 13 to 21 years).
There were 8 revisions (3 of 15 shoulders with concentric glenoids, and 5 of 16 shoulders with eccentric glenoids).
For those shoulders not revised, the average ASES score was 70.54 (range, 36.67 to 91.67).
Overall, active shoulder forward elevation and external rotation with the arm at 90° of abduction increased from 104° preoperatively to 141.8° (range, 45° to 180°) and 20.7° to 61.0° (range, 30° to 90°), respectively (p < 0.05), at the time of final follow-up.
Of those who required revision arthroplasty, the average patient age at the time of the index procedure was 51.0 years (range, 26 to 81 years), while those not requiring revision averaged 57.1 years (range, 27 to 63 years).
The overall Neer satisfaction rating was 25%.
The average Neer score and Neer rating for unrevised cases were significantly higher for concentric glenoid wear compared with eccentric glenoid wear (p = 0.015 and p = 0.001, respectively).
Patients who had concentric glenoid wear had higher EuroQol scores (p = 0.020).
The average Neer scores were 65.29 (range, 47 to 78) for primary osteoarthritis and 54.46 (range, 40 to 77) for secondary osteoarthritis (p = 0.036).
Conclusions
Only 25% of patients with glenohumeral osteoarthritis treated with shoulder hemiarthroplasty are satisfied with their outcome at an average of 17 years after the operation. Patients with concentric glenoid wear and primary osteoarthritis have better outcomes than those with eccentric glenoid wear and secondary osteoarthritis do, but patients in both groups experienced deterioration of results over time.
Level of evidence: Therapeutic Level IV. Copyright remains with the authors and publisher.