78 Neer hemiarthroplasties and 36 Neer total shoulder arthroplasties were performed at our institution, between January 1, 1976, and December 31, 1985, in 98 patients who were 50 years old or less. 2 patients (2 shoulders) died, and 4 patients (4 shoulders) were lost to follow-up. The remaining 74 hemiarthroplasties (95 per cent) in 64 patients and 34 total shoulder arthroplasties (94 per cent) in 31 patients were included in the clinical analysis as the preoperative and operative records were complete and the patients had been followed for at least 5 years (mean, 12.3 years) or until revision. All 114 shoulders were included in the survivorship analysis. Both total shoulder arthroplasty and hemiarthroplasty resulted in significant long-term relief of pain (p < 0.0001) as well as improvement in active abduction (p < 0.0001) and external rotation (p < 0.0001). However, with the numbers available, we could not detect a significant difference between the 2 procedures with respect to these variables. A complete set of radiographs was available for 68 (92 per cent) of the 74 shoulders that had a hemiarthroplasty and for 32 (94 per cent) of the 34 shoulders that had a total shoulder arthroplasty. A radiolucent line around the humeral component was noted after 16 (24 per cent) of the hemiarthroplasties and after 17 (53 per cent) of the total shoulder arthroplasties. A radiolucent line around the glenoid component was seen after 19 (59 per cent) of the total shoulder arthroplasties. Erosion of the glenoid was found after 46 (68 per cent) of the hemiarthroplasties. The results were graded according to a modification of the system of Neer et al. and of Cofield. 15 hemiarthroplasties led to an excellent result; 24, a satisfactory result; and 35, an unsatisfactory or unsuccessful result. 4 total shoulder arthroplasties were followed by an excellent result; 13, a satisfactory result; and 17, an unsatisfactory or unsuccessful result. The estimated survival of the hemiarthroplasty prostheses (with 95 per cent confidence intervals) was 92 per cent (86 to 98 per cent) at 5 years, 83 per cent (75 to 93 per cent) at 10 years, and 73 per cent (59 to 88 per cent) at 15 years. Analysis of the results in association with the 2 major diagnoses revealed that the risk of revision was higher for the 30 shoulders that had the hemiarthroplasty for the treatment of the sequelae of trauma than for the 28 that had the procedure for the treatment of rheumatoid arthritis (p = 0.017). The estimated survival of the total shoulder prostheses (with 95 per cent confidence intervals) was 97 per cent (92 to 100 per cent) at 5 years, 97 per cent (91 to 100 per cent) at 10 years, and 84 per cent (70 to 100 per cent) at 15 years. The risk of revision was higher for the 7 shoulders that had had a tear of the rotator cuff at the time of the operation than for the 27 that had not had one (p = 0.029). The data from the present study indicate that a shoulder arthroplasty provides marked long-term relief of pain and improvement in motion; however, nearly half of all young patients who have a shoulder arthroplasty have an unsatisfactory result according to a rating system. Care should be exercised when either a hemiarthroplasty or a total shoulder arthroplasty is offered to patients who are 50 years old or less.
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78 Neer hemiarthroplasties and 36 Neer total shoulder arthroplasties were performed at our institution, between January 1, 1976, and December 31, 1985, in 98 patients who were 50 years old or less. 2 patients (2 shoulders) died, and 4 patients (4 shoulders) were lost to follow-up. The remaining 74 hemiarthroplasties (95 per cent) in 64 patients and 34 total shoulder arthroplasties (94 per cent) in 31 patients were included in the clinical analysis as the preoperative and operative records were complete and the patients had been followed for at least 5 years (mean, 12.3 years) or until revision. All 114 shoulders were included in the survivorship analysis. Both total shoulder arthroplasty and hemiarthroplasty resulted in significant long-term relief of pain (p < 0.0001) as well as improvement in active abduction (p < 0.0001) and external rotation (p < 0.0001). However, with the numbers available, we could not detect a significant difference between the 2 procedures with respect to these variables. A complete set of radiographs was available for 68 (92 per cent) of the 74 shoulders that had a hemiarthroplasty and for 32 (94 per cent) of the 34 shoulders that had a total shoulder arthroplasty. A radiolucent line around the humeral component was noted after 16 (24 per cent) of the hemiarthroplasties and after 17 (53 per cent) of the total shoulder arthroplasties. A radiolucent line around the glenoid component was seen after 19 (59 per cent) of the total shoulder arthroplasties. Erosion of the glenoid was found after 46 (68 per cent) of the hemiarthroplasties. The results were graded according to a modification of the system of Neer et al. and of Cofield. 15 hemiarthroplasties led to an excellent result; 24, a satisfactory result; and 35, an unsatisfactory or unsuccessful result. 4 total shoulder arthroplasties were followed by an excellent result; 13, a satisfactory result; and 17, an unsatisfactory or unsuccessful result. The estimated survival of the hemiarthroplasty prostheses (with 95 per cent confidence intervals) was 92 per cent (86 to 98 per cent) at 5 years, 83 per cent (75 to 93 per cent) at 10 years, and 73 per cent (59 to 88 per cent) at 15 years. Analysis of the results in association with the 2 major diagnoses revealed that the risk of revision was higher for the 30 shoulders that had the hemiarthroplasty for the treatment of the sequelae of trauma than for the 28 that had the procedure for the treatment of rheumatoid arthritis (p = 0.017). The estimated survival of the total shoulder prostheses (with 95 per cent confidence intervals) was 97 per cent (92 to 100 per cent) at 5 years, 97 per cent (91 to 100 per cent) at 10 years, and 84 per cent (70 to 100 per cent) at 15 years. The risk of revision was higher for the 7 shoulders that had had a tear of the rotator cuff at the time of the operation than for the 27 that had not had one (p = 0.029). The data from the present study indicate that a shoulder arthroplasty provides marked long-term relief of pain and improvement in motion; however, nearly half of all young patients who have a shoulder arthroplasty have an unsatisfactory result according to a rating system. Care should be exercised when either a hemiarthroplasty or a total shoulder arthroplasty is offered to patients who are 50 years old or less.
Copyright remains with the authors and publisher.