Sperling (1998) — Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less. Long-term results.

Neer Hemiarthroplasty and Neer Total Shoulder Arthroplasty in Patients Fifty Years Old or Less. Long-Term Results.

·J Bone Joint Surg Am·1998·478 citations·Shoulder & Elbow

This retrospective cohort study reports long-term outcomes of 78 Neer hemiarthroplasties and 36 Neer TSAs performed exclusively in patients aged 50 or younger at a single institution (1976–1985). Mean clinical follow-up was 12.3 years. It is the first published series examining shoulder arthroplasty outcomes specifically in young patients.

Study Snapshot

Design

Retrospective cohort

Setting: Single center, Mayo Clinic, Rochester

Funding: None

Objective

Determine whether shoulder arthroplasty provides durable outcomes in patients ≤50 years old

Outcome(s)

Pain relief, range of motion, and implant survival at long-term follow-up

Subjects

114 shoulders (98 patients): 78 hemiarthroplasties, 36 total shoulder arthroplasties

78 shouldersNeer hemiarthroplasty
36 shouldersNeer total shoulder arthroplasty

Inclusion

Age ≤50 years
Neer hemiarthroplasty or TSA 1976–1985
Minimum 5-year follow-up or revised

Exclusion

Died postoperatively (n=2)
Lost to follow-up (n=4)

Follow-up

Minimum 5 years; hemi mean 11.7 years, TSA mean 13.6 years

Statistics

Wilcoxon signed-rank testWilcoxon rank-sum testFisher's exact testKaplan-Meier survivorship

Key Findings

Hemiarthroplasty survival drops meaningfully over time in young patients:
–92% at 5 years
–83% at 10 years
–73% at 15 years
–TSA fares better: 97% → 97% → 84% at 15 years
Despite reliable pain relief, nearly half of all patients had unsatisfactory results by the modified Neer/Cofield system.
–Excellent results: only 20% of hemiarthroplasties and 12% of TSAs.
–The most common reason was limited active abduction, not pain — functional restoration is the ceiling, not pain relief.
Prior ipsilateral surgery is the single most important risk factor to counsel patients about.
–Revision risk: p = 0.038.
–Unsatisfactory outcome: p = 0.017.
–Survival at 15 years with prior surgery: 57% vs 80% without.
Trauma-related diagnosis carries higher revision risk than rheumatoid arthritis after hemiarthroplasty (p = 0.017).
–Concurrent rotator cuff tear at time of TSA also significantly raises revision risk (p = 0.029).
Radiographic deterioration is nearly universal at long-term follow-up:
–Glenoid erosion after hemiarthroplasty. 68% (up from 49% preoperatively)
–Radiolucent lines around glenoid component after TSA. 59%
–Radiolucent lines around humeral component. 53% (TSA) vs 24% (hemiarthroplasty), p = 0.006
–Painful glenoid arthrosis was the reason for 11 of 15 hemiarthroplasty revisions.

Board PearlShoulder arthroplasty in patients ≤50 reliably relieves pain but yields unsatisfactory functional results in nearly half, with implant survival falling to 73% by 15 years.

Clinical Relevance

When a patient under 50 comes to clinic requesting shoulder arthroplasty, this paper defines the honest conversation you must have. Pain will almost certainly improve — both procedures produced significant relief (p < 0.0001). But a satisfying functional result is far from guaranteed, and by the modified Neer/Cofield system, roughly half will be unsatisfactory at 12+ years.

Three findings should directly shape your counseling and surgical planning: Prior ipsilateral surgery cuts 15-year survival to 57% and independently predicts unsatisfactory outcome. Exhaust joint-preserving options before committing. Trauma-related diagnosis predicts higher revision risk with hemiarthroplasty than rheumatoid arthritis does. Rotator cuff tears present at the time of TSA raise the revision risk significantly.

The radiographic story is equally sobering: glenoid erosion is present in 68% of hemiarthroplasty shoulders at final follow-up, and radiolucent lines surround the glenoid component in 59% of TSA shoulders. Numbers that will only grow as these patients age into their 60s and 70s.

Core

Neer Hemiarthroplasty and Neer Total Shoulder Arthroplasty in Patients Fifty Years Old or Less. Long-Term Results.

Sperling, Rowland, et al.·J Bone Joint Surg Am·1998·478 citations·Shoulder & Elbow

Neer Hemiarthroplasty and Neer Total Shoulder Arthroplasty in Patients Fifty Years Old or Less. Long-Term Results.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Neer Hemiarthroplasty and Neer Total Shoulder Arthroplasty in Patients Fifty Years Old or Less. Long-Term Results.

Study Snapshot

Key Findings

Clinical Relevance

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Neer Hemiarthroplasty and Neer Total Shoulder Arthroplasty in Patients Fifty Years Old or Less. Long-Term Results.

Study Snapshot

Key Findings

Clinical Relevance

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Neer Hemiarthroplasty and Neer Total Shoulder Arthroplasty in Patients Fifty Years Old or Less. Long-Term Results.

Study Snapshot

Key Findings

Clinical Relevance

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