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Humeral surface replacement for osteoarthritis.

Smith T, Gettmann A, Wellmann M, Pastor F, Struck M - Acta Orthop (2013)

Bottom Line: The implant size had no statistically significant influence on the functional outcome.Oversizing of the implants was common, but it had no statistically significant influence on the functional outcome.Inferior results were found in the presence of increased eccentric preoperative glenoid wear.

View Article: PubMed Central - PubMed

Affiliation: Shoulder, Knee, and Sports Medicine , Orthopaedic Clinic of Hanover Medical School at the Annastift Hospital, Hanover , Germany .

ABSTRACT

Background and purpose: Humeral resurfacing has shown promising results for osteoarthritis, but revisions for glenoid erosion have been reported frequently. We investigated the hypothesis that preoperative glenoid wear and postoperative progress of glenoid erosion would influence the clinical outcome.

Methods: We reviewed 61 resurfacing hemiarthroplasties (55 patients) for primary osteoarthritis. 6 patients were lost to follow-up and 5 had undergone revision arthroplasty. This left 50 shoulders in 44 patients (mean age 66 years) that were followed for mean 30 (12-44) months. Complications, revisions, and the age- and sex-related Constant score were assessed. Radiographs were evaluated for loosening and glenoid erosion according to Walch.

Results: Of the 50 shoulders that were functionally assessed, the average age- and sex-related Constant score was 73%. In patients with preoperative type-B2 glenoids, at 49% it was lower than in type-A1 glenoids (81%, p = 0.03) and in type-B1 glenoids (84%, p = 0.02). The average age- and sex-related Constant score for patients with type-A2 glenoids (60%) was lower than for type-A1 and -B1 glenoids and higher than for type-B2 glenoids, but the differences were not statistically significant. In the total population of 61 shoulders, the radiographs showed postoperative glenoid erosion in 38 cases and no humeral prosthetic loosening. Revision arthroplasty was performed in 11 cases after 28 (7-69) months. The implant size had no statistically significant influence on the functional outcome. The size was considered to be adequate in 28 of the 50 functionally assessed shoulders. In 21 cases, the implant size was too large and in 1 case it was too small.

Interpretation: We found frequent postoperative glenoid erosion and a high rate of revision arthroplasty after humeral resurfacing for primary osteoarthritis. Oversizing of the implants was common, but it had no statistically significant influence on the functional outcome. Inferior results were found in the presence of increased eccentric preoperative glenoid wear. Total shoulder arthroplasty should be considered in these patients.

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Related in: MedlinePlus

A. Antero-posterior view 2 days postoperatively. B. Axial view 2 days postoperatively, with posterior subluxation of the humeral head. C. Antero-posterior view 2 years postoperatively, with increased glenoid erosion and medialization of the joint line. D. Axial view 2 years postoperatively, with posterior subluxation of the humeral head and increased posterior glenoid erosion.
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Figure 1: A. Antero-posterior view 2 days postoperatively. B. Axial view 2 days postoperatively, with posterior subluxation of the humeral head. C. Antero-posterior view 2 years postoperatively, with increased glenoid erosion and medialization of the joint line. D. Axial view 2 years postoperatively, with posterior subluxation of the humeral head and increased posterior glenoid erosion.

Mentions: In the total population of 61 shoulders, radiographs showed no signs of loosening at the time of final follow-up. The size of the implants chosen was considered to be adequate in 28 of the 50 functionally assessed shoulders. In 21 cases, the implant size was too large and in 1 case it was too small. Only 1 case showed superior migration of the humeral head after a traumatic massive rotator cuff tear and was revised to a reverse prosthesis 3 months after humeral resurfacing. The qualitative review of the radiographs (i.e. without specific measurements) of all 61 osteoarthritis patients showed increased postoperative glenoid erosion in 38 cases at the time of the last follow-up examination (Figure A–D). Of the 11 cases of revision arthroplasty, 8 had glenoid erosion. There was no statistically significant correlation between the frequency of revision arthroplasty procedures and the different glenoid types according to Walch et al. (1999), the stages of osteoarthritis according to Samilson and Prieto (1983), or the correctness of the implant size chosen.


Humeral surface replacement for osteoarthritis.

Smith T, Gettmann A, Wellmann M, Pastor F, Struck M - Acta Orthop (2013)

A. Antero-posterior view 2 days postoperatively. B. Axial view 2 days postoperatively, with posterior subluxation of the humeral head. C. Antero-posterior view 2 years postoperatively, with increased glenoid erosion and medialization of the joint line. D. Axial view 2 years postoperatively, with posterior subluxation of the humeral head and increased posterior glenoid erosion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3822131&req=5

Figure 1: A. Antero-posterior view 2 days postoperatively. B. Axial view 2 days postoperatively, with posterior subluxation of the humeral head. C. Antero-posterior view 2 years postoperatively, with increased glenoid erosion and medialization of the joint line. D. Axial view 2 years postoperatively, with posterior subluxation of the humeral head and increased posterior glenoid erosion.
Mentions: In the total population of 61 shoulders, radiographs showed no signs of loosening at the time of final follow-up. The size of the implants chosen was considered to be adequate in 28 of the 50 functionally assessed shoulders. In 21 cases, the implant size was too large and in 1 case it was too small. Only 1 case showed superior migration of the humeral head after a traumatic massive rotator cuff tear and was revised to a reverse prosthesis 3 months after humeral resurfacing. The qualitative review of the radiographs (i.e. without specific measurements) of all 61 osteoarthritis patients showed increased postoperative glenoid erosion in 38 cases at the time of the last follow-up examination (Figure A–D). Of the 11 cases of revision arthroplasty, 8 had glenoid erosion. There was no statistically significant correlation between the frequency of revision arthroplasty procedures and the different glenoid types according to Walch et al. (1999), the stages of osteoarthritis according to Samilson and Prieto (1983), or the correctness of the implant size chosen.

Bottom Line: The implant size had no statistically significant influence on the functional outcome.Oversizing of the implants was common, but it had no statistically significant influence on the functional outcome.Inferior results were found in the presence of increased eccentric preoperative glenoid wear.

View Article: PubMed Central - PubMed

Affiliation: Shoulder, Knee, and Sports Medicine , Orthopaedic Clinic of Hanover Medical School at the Annastift Hospital, Hanover , Germany .

ABSTRACT

Background and purpose: Humeral resurfacing has shown promising results for osteoarthritis, but revisions for glenoid erosion have been reported frequently. We investigated the hypothesis that preoperative glenoid wear and postoperative progress of glenoid erosion would influence the clinical outcome.

Methods: We reviewed 61 resurfacing hemiarthroplasties (55 patients) for primary osteoarthritis. 6 patients were lost to follow-up and 5 had undergone revision arthroplasty. This left 50 shoulders in 44 patients (mean age 66 years) that were followed for mean 30 (12-44) months. Complications, revisions, and the age- and sex-related Constant score were assessed. Radiographs were evaluated for loosening and glenoid erosion according to Walch.

Results: Of the 50 shoulders that were functionally assessed, the average age- and sex-related Constant score was 73%. In patients with preoperative type-B2 glenoids, at 49% it was lower than in type-A1 glenoids (81%, p = 0.03) and in type-B1 glenoids (84%, p = 0.02). The average age- and sex-related Constant score for patients with type-A2 glenoids (60%) was lower than for type-A1 and -B1 glenoids and higher than for type-B2 glenoids, but the differences were not statistically significant. In the total population of 61 shoulders, the radiographs showed postoperative glenoid erosion in 38 cases and no humeral prosthetic loosening. Revision arthroplasty was performed in 11 cases after 28 (7-69) months. The implant size had no statistically significant influence on the functional outcome. The size was considered to be adequate in 28 of the 50 functionally assessed shoulders. In 21 cases, the implant size was too large and in 1 case it was too small.

Interpretation: We found frequent postoperative glenoid erosion and a high rate of revision arthroplasty after humeral resurfacing for primary osteoarthritis. Oversizing of the implants was common, but it had no statistically significant influence on the functional outcome. Inferior results were found in the presence of increased eccentric preoperative glenoid wear. Total shoulder arthroplasty should be considered in these patients.

Show MeSH
Related in: MedlinePlus