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 Shoulder/Elbow Test 5: The Shoulder and Elbow
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The Journal of Bone and Joint Surgery (American) 86:1446-1451 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Preoperative Factors Associated with Improvements in Shoulder Function After Humeral Hemiarthroplasty

Carolyn M. Hettrich, MD1, Edward Weldon, III, MD2, Richard S. Boorman, MD3, I. Moby Parsons, IV, MD4 and Frederick A. Matsen, III, MD1

1 Department of Orthopaedics and Sports Medicine, University of Washington, Box 356500, 1959 NE Pacific Street, Seattle, WA 98195-7660. E-mail address for F.A. Matsen: matsen{at}u.washington.edu
2 Bone and Joint Center, Straub Hospital and Clinic, 888 South King Street, Honolulu, HI 96813
3 50 Royal Oak Point NW, Calgary, AL T3G 5C5, Canada
4 Seacoast Orthopaedics and Sports Medicine, 237 Route 108, Somersworth, NH 03878

Investigation performed at the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from DePuy Orthopaedics Inc., in support of the Douglas T. Harryman II/DePuy Endowed Chair for Shoulder Research at the University of Washington. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The relationship between the characteristics of the shoulder that can be determined before humeral hemiarthroplasty and the functional improvement after surgery is not known. The goal of this study was to test the hypothesis that the functional outcome of this procedure correlated significantly with factors that are identifiable preoperatively.

Methods: The study group included seventy-one shoulders in sixty-eight patients undergoing hemiarthroplasty, performed by the same surgeon, for diagnoses other than acute fracture. The mean age of the patients was sixty-one years (range, thirty to eighty-three years). The results were characterized in terms of the change in self-assessed shoulder function and general health status at an average of forty-nine months (range, twenty-four to 142 months) after surgery.

Results: The preoperative absence of erosion of the glenoid was associated with greater improvement in shoulder function and level of comfort after hemiarthroplasty (p < 0.001). Shoulders that had not had previous surgery had greater functional improvement than did those that had previous surgery (p = 0.012). Shoulders with an intact rotator cuff showed significantly (p < 0.5) greater improvement in the ability to lift weight above shoulder level after hemiarthroplasty (p <0.5). With regard to diagnoses, shoulders with rheumatoid arthritis, capsulorrhaphy arthropathy, and cuff tear arthropathy had the least functional improvement, whereas those with osteonecrosis (p = 0.0004) and with primary (p = 0.02) and secondary degenerative joint disease (p = 0.03) had the greatest improvement. Patient age and gender did not significantly affect the outcome.

Conclusions: These results suggest that the functional improvement following humeral hemiarthroplasty is related to factors that are identifiable before surgery. These data may be of benefit in preoperative discussions with patients who have a shoulder disorder and are considering treatment with hemiarthroplasty.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


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