Sperling, J Bone Joint Surg Am 2002 - Shoulder Arthroplasty for Arthritis after Instability Surgery

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Shoulder Arthroplasty for Arthritis after Instability Surgery

Sperling, Cofield, et al.·J Bone Joint Surg Am·2002·131 citations·Retrospective cohort

Background

We are not aware of any large published studies regarding the intermediate to long-term results of shoulder arthroplasty performed for the treatment of osteoarthritis after instability surgery. Therefore, we reviewed the results of this procedure, the risk factors for an unsatisfactory outcome, and the rates of failure in our patients.

Methods

Between January 1, 1978, and December 31, 1997, 33 patients (33 shoulders) with glenohumeral arthritis after instability surgery were treated with a shoulder arthroplasty at our institution.
2 patients were excluded from the study: one died less than 2 years postoperatively, and one had not been managed by the senior surgeon.
The remaining 31 patients, including 21 patients who had had a total shoulder arthroplasty and 10 who had had a hemiarthroplasty, were followed for a minimum of 2 years (mean, 7 years) or until the time of revision surgery.
The mean age at the time of the shoulder arthroplasty was 46 years.

Results

Shoulder arthroplasty was associated with significant pain relief (p < 0.001) as well as significant improvement in external rotation (from 4 degrees to 43 degrees; p < 0.001) and active abduction (from 94 degrees to 141 degrees; p < 0.001).
There was not a significant difference between the hemiarthroplasty group and the total shoulder arthroplasty group with regard to postoperative external rotation, active abduction, or pain.
According to a modification of the rating system of Neer et al., there were 4 excellent, 2 satisfactory, and 4 unsatisfactory results in the hemiarthroplasty group and 3 excellent, 5 satisfactory, and 13 unsatisfactory results in the total shoulder arthroplasty group.
3 patients in the hemiarthroplasty group and 8 patients in the total shoulder arthroplasty group underwent revision surgery.
The estimated survival of the components (and 95% confidence interval) was 97% (91% to 100%) at 2 years, 86% (74% to 99%) at 5 years, and 61% (42% to 86%) at 10 years.

Conclusions

The data from the present study suggest that shoulder arthroplasty for the treatment of osteoarthritis of the glenohumeral joint following instability surgery in this relatively young group of patients provides pain relief and improved motion but is associated with high rates of revision surgery and unsatisfactory results due to component failure, instability, and pain due to glenoid arthritis.

Copyright remains with the authors and publisher.

Shoulder Arthroplasty for Arthritis after Instability Surgery

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Shoulder Arthroplasty for Arthritis after Instability Surgery

Sperling, Cofield, et al.·J Bone Joint Surg Am·2002·131 citations·Retrospective cohort

Background

We are not aware of any large published studies regarding the intermediate to long-term results of shoulder arthroplasty performed for the treatment of osteoarthritis after instability surgery. Therefore, we reviewed the results of this procedure, the risk factors for an unsatisfactory outcome, and the rates of failure in our patients.

Methods

Between January 1, 1978, and December 31, 1997, 33 patients (33 shoulders) with glenohumeral arthritis after instability surgery were treated with a shoulder arthroplasty at our institution.
2 patients were excluded from the study: one died less than 2 years postoperatively, and one had not been managed by the senior surgeon.
The remaining 31 patients, including 21 patients who had had a total shoulder arthroplasty and 10 who had had a hemiarthroplasty, were followed for a minimum of 2 years (mean, 7 years) or until the time of revision surgery.
The mean age at the time of the shoulder arthroplasty was 46 years.

Results

Shoulder arthroplasty was associated with significant pain relief (p < 0.001) as well as significant improvement in external rotation (from 4 degrees to 43 degrees; p < 0.001) and active abduction (from 94 degrees to 141 degrees; p < 0.001).
There was not a significant difference between the hemiarthroplasty group and the total shoulder arthroplasty group with regard to postoperative external rotation, active abduction, or pain.
According to a modification of the rating system of Neer et al., there were 4 excellent, 2 satisfactory, and 4 unsatisfactory results in the hemiarthroplasty group and 3 excellent, 5 satisfactory, and 13 unsatisfactory results in the total shoulder arthroplasty group.
3 patients in the hemiarthroplasty group and 8 patients in the total shoulder arthroplasty group underwent revision surgery.
The estimated survival of the components (and 95% confidence interval) was 97% (91% to 100%) at 2 years, 86% (74% to 99%) at 5 years, and 61% (42% to 86%) at 10 years.

Conclusions

The data from the present study suggest that shoulder arthroplasty for the treatment of osteoarthritis of the glenohumeral joint following instability surgery in this relatively young group of patients provides pain relief and improved motion but is associated with high rates of revision surgery and unsatisfactory results due to component failure, instability, and pain due to glenoid arthritis.

Copyright remains with the authors and publisher.

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