The Journal of Bone and Joint Surgery (American). 2005;87:2178-2185.
doi:10.2106/JBJS.D.02198
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Quality-of-Life Outcome Following Hemiarthroplasty or Total Shoulder Arthroplasty in Patients with Osteoarthritis

A Prospective, Randomized Trial

Ian K.Y. Lo, MD, FRCSC1, Robert B. Litchfield, MD, FRCSC2, Sharon Griffin, CSS2, Ken Faber, MD, FRCSC3, Stuart D. Patterson, MD, FRCSC4 and Alexandra Kirkley, MD, FRCSC5

1 University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada
2 Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON N6A 3K7, Canada. E-mail address for S. Griffin: sharon.griffin{at}uwo.ca
3 Hand and Upper Limb Centre, St. Joseph's Health Care, 268 Grosvenor Street, London, ON N6A 4V2, Canada
4 Central Florida Orthopaedic Surgery Associates, 2000 East Edgewood Drive, Suite 112, Lakeland, FL 33803
5 Deceased

Investigation performed at the Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from 3M Canada. 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, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Both total shoulder arthroplasty and hemiarthroplasty have been used commonly to treat severe osteoarthritis of the shoulder; however, their effect on disease-specific quality-of-life outcome is unknown. The purpose of this study was to compare the quality-of-life outcome following hemiarthroplasty with that following total shoulder arthroplasty in patients with osteoarthritis of the shoulder.

Methods: Forty-two patients with a diagnosis of osteoarthritis of the shoulder were randomized to receive a hemiarthroplasty or a total shoulder arthroplasty. One patient died, and all others were evaluated preoperatively and at six weeks and three, six, twelve, eighteen, and twenty-four months postoperatively with use of a standardized format including a disease-specific quality-of-life measurement tool (Western Ontario Osteoarthritis of the Shoulder [WOOS] index), general shoulder rating scales (University of California at Los Angeles [UCLA] shoulder scale, Constant score, and American Shoulder and Elbow Surgeons [ASES] evaluation form), general pain scales (McGill pain score and visual analogue scale), and a global health measure (Short Form-36 [SF-36]). When a patient required revision of a hemiarthroplasty to a total shoulder arthroplasty, the last score before he or she "crossed over" was used for the analysis.

Results: Significant improvements in disease-specific quality of life were seen two years after both the total shoulder arthroplasties and the hemiarthroplasties. There were no significant differences in quality of life (WOOS score) between the group treated with total shoulder arthroplasty and that treated with hemiarthroplasty (90.6 ± 13.2 and 81.5 ± 24.1 points, respectively; p = 0.18). The other outcome measures demonstrated similar findings. Two patients in the hemiarthroplasty group crossed over to the other group by undergoing a revision to a total shoulder arthroplasty because of glenoid arthrosis.

Conclusions: Both total shoulder arthroplasty and hemiarthroplasty improve disease-specific and general quality-of-life measurements. With the small number of patients in our study, we found no significant differences in these measurements between the two treatment groups.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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