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Treatment of Glenohumeral Arthritis with a Hemiarthroplasty: A Minimum Five-Year Follow-up Outcome Study

¹ Health Science Center at San Antonio, University of Texas, Mail Code 7774, 7703 Floyd Curl Drive, San Antonio, TX 78284-7774. E-mail ad-dress for M.A. Wirth: wirth{at}uthscsa.edu. E-mail address for C.A. Rockwood Jr.: rockwood{at}uthscsa.edu
² DePuy Orthopaedics, 700 Orthopaedic Drive, Warsaw, IN 46581-0988

Investigation performed at the University of Texas Health Science Center at San Antonio, San Antonio, Texas

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).

NOTE: The authors thank Andrea Hicks for her assistance in the preparation of this work.

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from DePuy, a Johnson and Johnson Company. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy, a Johnson and Johnson company). 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.

Methods: Fifty-seven consecutive patients (sixty-four shoulders) who had osteoarthritis of the glenohumeral joint, without advanced disease in the glenoid, were treated with hemiarthroplasty. In each instance, a modular prosthesis was implanted. Clinical assessment was performed preoperatively and at one-year intervals postoperatively for at least five years with use of patient self-assessment instruments, including the American Shoulder and Elbow Surgeons questionnaire, the Simple Shoulder Test, and a visual analog pain scale. A detailed radiographic analysis was performed to determine the presence of glenohumeral subluxation, periprosthetic radiolucency, and glenoid bone loss.

Results: Forty-three patients (fifty shoulders) were followed for a minimum of five years (mean, 7.5 years). Of the remaining fourteen patients (fourteen shoulders), ten were lost to follow-up, three had died, and one was excluded. For the Simple Shoulder Test, and for every visual analog scale measure, the results at the final follow-up evaluation were significantly better than the preoperative results (p < 0.0001 for each). The mean Simple Shoulder Test score at the time of the final follow-up was 9.4 positive responses compared with 9.7 positive responses at the two-year evaluation (p = 0.32), and the mean visual analog scale score for pain was 18.6 points compared with 14.9 points at two years (p = 0.45). Radiographic analysis showed the majority of stems had either no lucency or lucencies only near the tip of the stem. Glenoid bone loss and subluxation improved postoperatively, and the results were maintained at the final follow-up evaluation.

Conclusions: Shoulder hemiarthroplasty provides sustained good-to-excellent pain relief and functional improvement at five to ten years postoperatively in carefully selected patients with osteoarthritis.

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

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Treatment of Glenohumeral Arthritis with a Hemiarthroplasty. Surgical Technique

Michael A. Wirth, R. Stacy Tapscott, Carleton Southworth, and Charles A. Rockwood, Jr.
JBJS 2007 89: 10-25. [Abstract] [Full Text]  

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