78 Neer hemiarthroplasties and 36 Neer total shoulder arthroplasties were performed in patients aged 50 years or younger between January 1, 1976, and December 31, 1985. 62 hemiarthroplasties and 29 total shoulder arthroplasties with complete preoperative evaluation, operative records, and a minimum 15-year follow-up (mean, 16.8 years) or follow-up until revision were included in the clinical analysis. 16 patients died, and 7 were lost to follow-up. All 114 shoulders were included in the survival analysis. There was significant long-term pain relief (P .01) and improvement in active abduction (P .01) and external rotation (P .01) with both procedures. There was not a significant difference between total shoulder arthroplasty and hemiarthroplasty with regard to pain relief, abduction, or external rotation. Radiographs were available for 53 hemiarthroplasties and 25 total shoulder arthroplasties with a minimum 10-year follow-up. Humeral periprosthetic lucency was present more frequently after total shoulder arthroplasty (60%) compared with hemiarthroplasty (34%) (P .0079). Glenoid erosion was present in 38 of 53 hemiarthroplasties (72%). Glenoid periprosthetic lucency was present in 19 of 25 total shoulder arthroplasties (76%). The results were graded by use of a modified Neer result rating system. Among the hemiarthroplasties, there were 6 excellent (10%), 19 satisfactory (30%), and 37 unsatisfactory results (60%). Among total shoulder arthroplasties, there were 6 excellent (21%), 9 satisfactory (31%), and 14 unsatisfactory results (48%). The estimated survival rate for hemiarthroplasty was 82% (95% CI, 74%-92%) at 10 years and 75% (95% CI, 64%-86%) at 20 years. The estimated survival rate for total shoulder arthroplasty was 97% (95% CI, 91%-100%) at 10 years and 84% (95% CI, 68%-98%) at 20 years. The data from this study indicate that there is marked long-term pain relief and improvement in motion with shoulder arthroplasty. However, there is a moderate rate of hemiarthroplasty revision for painful glenoid arthritis. Unsatisfactory result ratings were most commonly a result of motion restriction from soft-tissue abnormalities. Great care must be exercised, and alternative methods of treatment considered, before either hemiarthroplasty or total shoulder arthroplasty is offered to patients aged 50 years or younger.
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78 Neer hemiarthroplasties and 36 Neer total shoulder arthroplasties were performed in patients aged 50 years or younger between January 1, 1976, and December 31, 1985. 62 hemiarthroplasties and 29 total shoulder arthroplasties with complete preoperative evaluation, operative records, and a minimum 15-year follow-up (mean, 16.8 years) or follow-up until revision were included in the clinical analysis. 16 patients died, and 7 were lost to follow-up. All 114 shoulders were included in the survival analysis. There was significant long-term pain relief (P .01) and improvement in active abduction (P .01) and external rotation (P .01) with both procedures. There was not a significant difference between total shoulder arthroplasty and hemiarthroplasty with regard to pain relief, abduction, or external rotation. Radiographs were available for 53 hemiarthroplasties and 25 total shoulder arthroplasties with a minimum 10-year follow-up. Humeral periprosthetic lucency was present more frequently after total shoulder arthroplasty (60%) compared with hemiarthroplasty (34%) (P .0079). Glenoid erosion was present in 38 of 53 hemiarthroplasties (72%). Glenoid periprosthetic lucency was present in 19 of 25 total shoulder arthroplasties (76%). The results were graded by use of a modified Neer result rating system. Among the hemiarthroplasties, there were 6 excellent (10%), 19 satisfactory (30%), and 37 unsatisfactory results (60%). Among total shoulder arthroplasties, there were 6 excellent (21%), 9 satisfactory (31%), and 14 unsatisfactory results (48%). The estimated survival rate for hemiarthroplasty was 82% (95% CI, 74%-92%) at 10 years and 75% (95% CI, 64%-86%) at 20 years. The estimated survival rate for total shoulder arthroplasty was 97% (95% CI, 91%-100%) at 10 years and 84% (95% CI, 68%-98%) at 20 years. The data from this study indicate that there is marked long-term pain relief and improvement in motion with shoulder arthroplasty. However, there is a moderate rate of hemiarthroplasty revision for painful glenoid arthritis. Unsatisfactory result ratings were most commonly a result of motion restriction from soft-tissue abnormalities. Great care must be exercised, and alternative methods of treatment considered, before either hemiarthroplasty or total shoulder arthroplasty is offered to patients aged 50 years or younger.
Copyright remains with the authors and publisher.