The Journal of Bone and Joint Surgery (American). 2006;88:2637-2644.
doi:10.2106/JBJS.E.01383
© 2006 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the exam for this article:
 Shoulder/Elbow Test 17: Winter 2007 (publication date February 15, 2007; ex...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Rispoli, D. M.
Right arrow Articles by Cofield, R. H.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Rispoli, D. M.
Right arrow Articles by Cofield, R. H.
Related Collections
Right arrow Shoulder
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Humeral Head Replacement for the Treatment of Osteoarthritis

Damian M. Rispoli, MD, Lieutenant Colonel1, John W. Sperling, MD1, George S. Athwal, MD, FRCSC1, Cathy D. Schleck, BS1 and Robert H. Cofield, MD1

1 Department of Orthopedic Surgery (D.M.R., J.W.S., G.S.A., and R.H.C.) and Division of Biostatistics (C.D.S.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905

Investigation performed at the Department of Orthopedic Surgery and Division of Biostatistics, Mayo Clinic, Rochester, Minnesota

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).

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Smith and Nephew). In addition, a commercial entity (Smith and Nephew) 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: Humeral head replacement has been used successfully for the treatment of osteoarthritis of the shoulder for decades. The purpose of this study was to define the results of this form of treatment, the risk factors for an unsatisfactory outcome, and the rates of failure over time.

Methods: Between 1978 and 1997, sixty humeral head replacements were performed at our institution for the treatment of osteoarthritis. Five patients (seven shoulders) died less than five years postoperatively, and one patient (two shoulders) was lost to follow-up. Fifty-one humeral head replacements in forty-nine patients with a complete postoperative evaluation and operative records who had been followed for a minimum of five years (mean, 11.3 years) or until revision were included in the study. All sixty shoulders were included in the survival analysis.

Results: Overall, there was significant long-term pain relief (p < 0.0001) as well as improvement in active abduction (p < 0.0001), internal rotation (p < 0.024), and external rotation (p < 0.0001) following the humeral head replacement. However, moderate pain was reported in nine shoulders and severe pain, in seven. Ten of the fifty-one shoulders underwent revision surgery, which was done to treat painful glenoid arthrosis in nine of the ten. Radiographs were available for thirty-nine shoulders, and they demonstrated an increase in glenoid erosion at a mean of 10.7 years postoperatively (p < 0.0001). Five shoulders had humeral periprosthetic lucent lines of 1.5 mm in thickness, and three of them had a complete line; one humeral component had shifted in position. According to a modification of the Neer result rating system, there were ten excellent results, twenty satisfactory results, and twenty-one unsatisfactory results.

Conclusions: Substantial clinical improvement can occur after humeral head replacement for osteoarthritis of the shoulder, but there is a high rate of unsatisfactory results and revision surgery. The decision as to whether this is the optimal surgical procedure for the treatment of osteoarthritis of the shoulder requires careful consideration.

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


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
D. Cuff, D. Pupello, N. Virani, J. Levy, and M. Frankle
Reverse Shoulder Arthroplasty for the Treatment of Rotator Cuff Deficiency
J. Bone Joint Surg. Am., June 1, 2008; 90(6): 1244 - 1251.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. L. Ramsey, C. L. Getz, and B. O. Parsons
What's New in Shoulder and Elbow Surgery
J. Bone Joint Surg. Am., March 1, 2008; 90(3): 677 - 687.
[Full Text] [PDF]