The Journal of Bone and Joint Surgery (American). 2008;90:287-298.
doi:10.2106/JBJS.H.00312
© 2008 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
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 Similar articles in PubMed
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
Google Scholar
Right arrow Articles by Fuerst, M.
Right arrow Articles by Rüther, W.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fuerst, M.
Right arrow Articles by Rüther, W.
Related Collections
Right arrow Surgical Techniques
Right arrow Shoulder
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

The DUROM Cup Humeral Surface Replacement in Patients with Rheumatoid Arthritis

Surgical Technique

Martin Fuerst, MD1, Bernd Fink, MD2 and Wolfgang Rüther, MD1

1 Department of Orthopedics, Rheumaklinik Bad Bramstedt, Oskar-Alexander-Strasse 26, D-24576, Bad Bramstedt, Germany. E-mail address for M. Fuerst: mfuerst{at}uke.uni-hamburg.de
2 Department of Endoprosthetic, General Orthopedic, and Rheumatoid Surgery, Orthopedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71703 Markgröningen, Germany

Investigation performed at the Department of Orthopedics, Rheumaklinik Bad Bramstedt, Bad Bramstedt, Germany, and the Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 89-A, pp. 1756-62, August 2007

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Zimmer Company, Winterthur, Switzerland) 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 one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

BACKGROUND: Rheumatoid arthritis often leads to severe destruction of the glenohumeral joint, including synovitis and inflammation-induced alterations of the rotator cuff. Cup arthroplasty, or surface replacement of the shoulder, was introduced in the 1980s. The aim of this study was to evaluate the midterm results of the DUROM cup surface replacement for patients with rheumatoid arthritis affecting the glenohumeral joint.

METHODS: From 1997 to 2000, forty-two DUROM cup hemiprostheses were implanted in a cohort of thirty-five patients (forty-two shoulders), who were evaluated preoperatively and again at three, twelve, and more than sixty months postoperatively. Six patients (seven shoulders) were lost to follow-up. Thirty-five shoulders in twenty-nine patients (twenty-one women and eight men with an average age of 61.4 years) could be evaluated prospectively after an average follow-up period of 73.1 months. Patients were evaluated clinically with the use of the Constant score, and a detailed radiographic analysis was performed to determine the presence of endoprosthetic loosening, glenohumeral subluxation, and glenoid bone loss.

RESULTS: The mean Constant score for the thirty-five shoulders increased from 20.8 points preoperatively to 64.3 points at a mean of 73.1 months postoperatively. There were three revisions: one to replace an implant that was too large, another to treat glenoid erosion, and a third due to loosening of the implant. No additional cases of loosening of the prosthesis or changes in cup position were observed radiographically. Over the five-year follow-up period, proximal migration of the cup increased in 63% of the shoulders, and glenoid depth increased in 31%. With the numbers studied, no differences in clinical outcome were identified between patients with a massive rotator cuff tear and those with a smaller or no tear.

CONCLUSIONS: The midterm results of the cemented DUROM cup surface replacement for patients with advanced rheumatoid arthritis of the shoulder are very encouraging, even for patients with a massive tear of the rotator cuff. The advantage of this cup arthroplasty is the less complex bone-sparing surgery. In the event of failure of the implant, other reliable salvage options remain available.

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

ORIGINAL ABSTRACT CITATION: "The DUROM Cup Humeral Surface Replacement in Patients with Rheumatoid Arthritis" (2007;89:1756-62).


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