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Treatment of Glenohumeral Arthritis with a Hemiarthroplasty

Surgical Technique

¹ Health Science Center at San Antonio, University of Texas, Mail Code 7774, 7703 Floyd Curl Drive, San Antonio, TX 78284-7774. E-mail address 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

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 88-A, pp. 964-973, May 2006

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DePuy, Johnson and Johnson). Also, a commercial entity (DePuy, Johnson and Johnson) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart{at}haderermuller.com).

Glenohumeral hemiarthroplasty is well established as a method to treat glenohumeral arthritis. This study was designed to report longer-term results and to provide a decision model to assist surgeons in achieving successful outcomes. Our selection strategy for hemiarthroplasty included shoulders with (1) a concentric glenoid with eburnated bone, (2) a nonconcentric glenoid that could be converted to a smooth concentric surface, and (3) a humeral head centered within the glenoid after soft-tissue balancing.

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.

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Related articles in JBJS:

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

Michael A. Wirth, R. Stacy Tapscott, Carleton Southworth, and Charles A. Rockwood, Jr.
JBJS 2006 88: 964-973. [Abstract] [Full Text]  

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