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Purpose:
The aim of this multicentre cohort study was to evaluate the midterm outcomes and survival after cementless stemless resurfacing arthroplasty (CSRA) in a series of 33 shoulders in 27 patients with primary osteoarthritis.
Methods:
Clinical outcome assessment included: Constant-Murley score (CMS); Simple Shoulder Test (SST); Disability of...
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Introduction
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Background/Aim: Studies on likely sociodemographic and pre-surgical determinants of hand function and satisfaction following
pyrocarbon proximal interphalangeal joint arthroplasty (PPIJA) are scarce. The primary aim of this study was to explore the association
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Purpose of review:
The incidence of shoulder arthroplasty is increasing dramatically for primary arthroplasty but also for revision arthroplasty. Revision to reverse total shoulder arthroplasty is increasingly the salvage operation for failed primary arthroplasty. The purpose of this review is to explore the indications for and results of revision...
Purpose
We evaluated the long-term safety, mobility and complications of cervical total disc arthroplasty with the Baguera ® C prosthesis over 10 years.
Methods
We included 91 patients treated by arthroplasty for cervical degenerative disc disease. A total of 113 prostheses were implanted (50 one-level, 44 two-level and 19 hybrid constructs). They...
Citations
... Only a few cases have been reported in the literature. [1][2][3]5,6,12,14 In periprosthetic fractures after shoulder resurfacing, the main treatment option is anatomic or reverse shoulder arthroplasty. Successful treatment with open reduction and internal fixation with a plate has not yet been reported in the literature. ...
... Periprosthetic fractures after Copeland cementless surface replacement arthroplasty are most commonly treated with revision shoulder arthroplasty using total or reverse shoulder replacement. 3,5,9,14 The overall risk of periprosthetic fractures after shoulder arthroplasty is relatively low, ranging between 0.6% and 3%. 11 In a series of 4019 TSA and humeral head replacements, the incidence of postoperative periprosthetic fractures was 0.4% (18/4019). ...
Case
Periprosthetic fractures around a shoulder replacement are rather uncommon injuries and commonly difficult to treat. We present a case of a 58-year old patient who sustained a traumatic proximal humerus periprosthetic fracture around a well-fixed Copeland cementless surface replacement arthroplasty. The fracture was treated with open reduction and internal fixation with a plate, preserving shoulder function. No need for revision surgery or arthroplasty was necessary after a 4 year follow up.
Conclusion
We describe plate fixation as a successful treatment option for periprosthetic proximal humerus fractures around a well-fixed Copeland cementless surface replacement arthroplasty.
... Over the years, satisfactory revision rates in the range of 0%-23%, patientreported outcome measures and patient satisfaction have been reported not only from the designer's institution, but also from independent centers. [3][4][5][6][7][8] Although not as thoroughly reviewed, the Global C.A.P. HHRI was recently shown to provide functional outcomes and survival rates similar to that of the Copeland HHRI. 9 For both implants, most available studies are of retrospective nature. ...
In a randomized controlled setting, medium‐term implant migration and long‐term clinical outcomes were compared for the Copeland and the Global C.A.P. humeral head resurfacing implants (HHRI). Thirty‐two patients (mean age 63 years) were randomly allocated to a Copeland (n = 14) or Global C.A.P. (n = 18) HHRI. Patients were followed for 5 years with radiostereometry, Constant Shoulder Score, and the Western Ontario Osteoarthritis of the Shoulder Index (WOOS). WOOS and revision status were also obtained cross‐sectionally at a mean 10‐year follow‐up. At the 5‐year follow‐up, total translation (TT) was 0.75 mm (95% confidence interval [CI]: 0.53–0.97) for the Copeland HHRIs and 1.15 mm (95% CI: 0.85–1.46) for the Global C.A.P. HHRIs (p = 0.04), but the clinical scores were similar at all follow‐ups. The cumulative risks of revision at 5 and 10 years were 29% and 43% for Copeland and 35% and 41% for Global C.A.P HHRIs (p > 0.7). No implants were loose at revision, but HHRIs that were later revised followed an early offset‐increasing migration pattern with medial translation and lift‐off resulting in a mean 0.53 mm (95% CI: 0.18–0.88) higher TT at the 1‐year follow‐up compared to non‐revised HHRIs. In conclusion, the Global C.A.P. HHRI had higher TT compared with the Copeland HHRI, but clinical scores and revision rates were similar. Nonetheless, revision rates were high and challenge the use of HHRIs. Interestingly, an early radiostereometry evaluated HHRI migration pattern with increased off‐set predicted later implant revision.
... This is in contrast to previous smaller studies that indicated reasons other than osteoarthritis to account for a higher percentage of joint replacements in the younger age group. 9,16,20 Saltzman in 2010 reported on 172 patients aged <50 years and found 79% had a diagnosis other than primary degenerative joint disease compared to 34% of patients aged >50 years. 9 Revision rate and survivorship in young patients All classes of shoulder replacement had comparable CPR in patients aged <55 years. ...
... A multicentered cohort study of 33 shoulders treated with the Copeland shoulder resurfacing showed that 45% of patients had glenoid erosion on x-ray at 7 year follow-up. 20 Similarly, a multicentered study of 419 patients with mean age of 49 years, treated with HA using a metal head demonstrated that painful glenoid erosions accounted for 9.5% of the 11% of revisions at 10 years. 25 The cause of glenoid erosion in HRA and HA is not fully understood. ...
Background
Shoulder replacement is a reliable treatment for the relief of pain and improvement of function in patients with glenohumeral arthritis, rotator cuff arthropathy, osteonecrosis and fracture. Limited data is available comparing revision rates for the different types of shoulder replacement when used in younger patients. This study aims to compare the survivorship of hemi resurfacing, stemmed hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty in younger patients using data from a large national arthroplasty registry.
Methods
Data from the Australian Orthopaedic Association National Joint Replacement Registry was obtained for the period 16 April 2004–31 December 2018. The study population included all shoulder arthroplasty patients aged <65 years. These were stratified into two groups: <55 years and 55–64 years. A total of 8742 primary shoulder arthroplasty procedures were analysed (1936 procedures in the <55 years and 6806 in the 55–64 years age group).
Results
In the <55 years age group, there was no difference in revision rate for total shoulder arthroplasty versus reverse total shoulder arthroplasty at any time point. Reverse total shoulder arthroplasty had a lower revision rate after six months when compared to hemi resurfacing (HRA) (p = 0.031). Also, reverse total shoulder arthroplasty had a higher early rate of revision in the first 12 months compared to hemiarthroplasty (p = 0.018). However, from 2 years reverse total shoulder arthroplasty had a lower revision rate overall (p = 0.029). In the 55–64 years patient age group, reverse total shoulder arthroplasty had a lower earlier revision rate. This was statistically significant compared to hemi resurfacing (HRA) (p = 0.028), hemiarthroplasty (p = 0.049) and total shoulder arthroplasty (p < 0.001).
Conclusion
This study demonstrated that for patients aged <55 years there was no significant difference in the rate of revision when total shoulder arthroplasty and reverse total shoulder arthroplasty were compared. reverse total shoulder arthroplasty had a lower rate of revision when compared to hemi resurfacing and hemiarthroplasty after 2 years. reverse total shoulder arthroplasty had the lowest comparative revision rate in patients aged 55–64 years overall.
... Kaplan-Meier survival curve with revision surgery as endpoint.Global CAP: long-term results 46% of the revisions were due to glenoid erosion. This finding is in line with the findings of Verstraelen et al,43 who observed erosion of the glenoid in 45.5% of patients after Copeland Mark III arthroplasty. Herschel et al22 described risk factors for glenoid erosion in patients with shoulder hemiarthroplasty. ...
Background
Treatment with uncemented resurfacing shoulder hemiarthroplasty has proven to be viable for patients with end-stage osteoarthritis at short- and mid-term follow-up. This study was essential to determine whether those outcomes will endure. This study presents the long-term results of the Global C.A.P. uncemented resurfacing shoulder hemiarthroplasty (DePuy Synthes).
Methods
All patients diagnosed with glenohumeral osteoarthritis and an intact and clinically sufficient rotator cuff who underwent uncemented resurfacing shoulder hemiarthroplasty between 2007 and 2009 were included. All patients who completed the 10-year follow-up assessments were used for analysis. The visual analogue pain scale, the Dutch version of the Simple Shoulder Test, the Constant Score, the SF-12 scores and physical examination were evaluated preoperatively and postoperatively on annual basis. All complications and revisions were documented. Radiographs were evaluated for loosening, (sub)luxation, migration and glenoid erosion.
Results
23 out of 48 patients (48%, (18 women and 5 men)) were available for the 10-year follow-up assessments and were used for analysis. The main reasons for drop out were revision (27%) and decease (10%). Of the remaining patients the mean follow-up was 10.9 years (ranged between 9 and 13 years). The visual analogue pain scale 6.5 ± 2.1 to 0.7 ±1.6 (p=0.000), the Dutch Simple Shoulder Test 22 ± 22 to 79 ± 22 (p=0.000), the Constant Score 40 ± 29 to 70 ± 8 (p=0.000) and the SF-12 physical scores 36 ± 7 to 41 ± 12 (p=0.001) improved significantly compared to preoperative scores. Thirteen (27%) of the initial 48 patients underwent revision surgery. Most revisions were seen within 7 years postoperatively.
Conclusion
Two revisions have been performed from mid-to long-term due to increased functional outcomes and absence of signs of loosening. Nevertheless, the high overall revision rate of 27% between short and long-term follow-up reflects the need to limit its use for treatment of glenohumeral osteoarthritis.
... Despite the promising results from these early case series, more recent larger multicenter studies and joint registry data have revealed much higher revision rates and highlighted the problem of glenoid erosion that occurs when a metallic humeral component is used for resurfacing the humerus against the native glenoid. 2 A multicenter cohort study of 33 shoulders treated with the Copeland shoulder resurfacing procedure showed that 45% of patients had glenoid erosion on radiographs at 7 years' follow-up. 20 The AOANJRR data revealed that for hemi-resurfacing, glenoid erosion and pain were the 2 most common reasons for revision in patients aged <55 years (27.3% and 25.0%, respectively) and those aged 55-64 years (27.8% and 22%, respectively). 2 In our study, pain accounted for 28.6% of pyrocarbon revisions in the study group aged <55 years. Pain may occur due to the pyrocarbon surface moving against damaged articular cartilage or may have been recorded as the reason for revision when no other distinct cause could be identified. ...
Background:
The optimal surgical management of glenohumeral osteoarthritis in young patients remains an unsolved problem. Humeral resurfacing hemiarthroplasty and stemmed hemiarthroplasty using metallic heads are two surgical options that avoid the complications of loosening or wear of the glenoid component seen in total shoulder arthroplasty. Despite the potential benefits, improvement in survivorship has not been demonstrated from joint registry or other studies at mid-term follow-up. This is due predominantly to glenoid erosion and pain that occurs when the metal resurfaced head articulates with the native glenoid. The use of pyrocarbon as a resurfacing material has been proposed as an alternative bearing surface thought to reduce glenoid erosion due to marked reduction in wear rates in vitro. This study aims to compare the survivorship of shoulder hemi resurfacing utilizing pyrolytic carbon to shoulder hemi resurfacing and stemmed hemiarthroplasty using metallic heads.
Methods:
Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed for all patients aged <55 years who had undergone a primary shoulder replacement for osteoarthritis from 16 April 2004 to 31 December 2019. The outcome of shoulder procedures using pyrocarbon hemi resurfacing were compared to procedures using metal hemi resurfacing and metal hemi stemmed arthroplasty. Reason for revision of each arthroplasty class was analyzed. The analyses were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazards models.
Results:
There were 393 primary shoulder procedures of which 163 were pyrocarbon hemi resurfacing, 163 were metal hemi resurfacing and 67 metal stemmed hemiarthroplasties. The CPR at 6 years was 8.9% for pyrocarbon hemi resurfacing 17.1% for metal hemi resurfacing and 17.5% for metal hemi stemmed. Pyrocarbon hemi resurfacing had a statistically lower revision rate compared to other hemi resurfacing prostheses (HR=0.41 (95% CI 0.18, 0.93), p=0.032). Pain, prosthesis fracture and infection were the key reasons for revision. No pyrocarbon hemi resurfacings were revised for glenoid erosion. In male patients, pyrocarbon humeral resurfacing had a lower cumulative percent revision compared to metal stemmed hemiarthroplasty (HR=0.32 (95% CI 0.11, 0.93), p=0.037).
Conclusion:
Pyrocarbon humeral resurfacing arthroplasty had statistically lower revision rates at mid-term follow-up in patients aged <55 years compared to other hemi resurfacing.
... To reduce the aforementioned potential risks, the Copeland Mark 3 resurfacing arthroplasty was, for the first time, introduced in 1993 as the first-generation RHA (Fig. 1b), which is a less invasive humeral head surface replacement with minimal bone resection. Subsequently, some studies reported that RHA could provide recovery of pain-free functional motion and facilitate the revision to TSA or RSA despite high complication rate during long-term follow-ups [30][31][32][33][34][35][36][37]. ...
... Especially, RHA has been promoted as a bone-sparing alternative to SHA for over ten years among doctors and patients. Various types of resurfacing procedures have been described in terms of shortand mid-term clinical effectiveness by mounting studies [32,53,[57][58][59][60] and a recent systemic review [61] suggested that resurfacing replacements could provide a significant improvement in pain, motion, and standardized outcome scores. ...
Background
Though total shoulder arthroplasty (TSA) has been an acknowledged treatment option for glenohumeral osteoarthritis, resurfacing hemiarthroplasty (RHA) and stemmed hemiarthroplasty (SHA) may be preferred in some circumstances by surgeons, especially for treating young or active patients. However, decision-making between the RHA and SHA is controversial. Therefore, we conducted a meta-analysis to systematically compare two surgical procedures in terms of postoperative functional outcomes, range of motion (ROM), pain relief, complication rates, risk of revision.
Methods
The PubMed, Embase, Web of Science and Cochrane Library were searched from inception to January 1, 2020, for all articles that compared the clinical effectiveness and safety of RHA with SHA. All eligible studies were selected based on certain screening criteria. Two investigators independently conducted the quality assessment and extracted the data. Fixed-effect and random-effect models were used for pooled results according to the degree of heterogeneity. All statistical analyses were performed by employing Stata software 14.0.
Results
A total of six comparative studies involving 2568 shoulders (1356 RHA and 1212 SHA) were included in the final analysis. Patients were followed up for at least 1 year in each study. Pooled results showed that RHA was associated with a better visual analog scale (SMD 0.61, p = 0.001) but higher revision rates (OR 1.50, p = 0.016) when compared to SHA. There were no significant differences in functional outcomes, such as Constant-Murley score (SMD 0.06, P = 0.878), American Shoulder and Elbow Surgeons score (SMD 0.05, P = 0.880), Western Ontario Osteoarthritis of the Shoulder index (SMD 0.43, p = 0.258) and quick-Disabilities of the Arm, Shoulder and Hand score (SMD 0.06, p = 0.669). In addition, no differences were observed in forward flexion (SMD 0.16, p = 0.622), external rotation (SMD -0.17, P = 0.741) and overall complication rates (OR 1.42, p = 0.198).
Conclusion
This is the first meta-analysis to investigate the clinical efficacy and safety of RHA in comparison with SHA for the treatment of glenohumeral osteoarthritis. The results demonstrated that the two surgical techniques were equivalent in terms of postoperative functional outcomes and complication rate. However, RHA provided greater pain relief but posed a higher risk for revision than SHA. More high-quality studies with long-term follow up are warranted to give more convincing evidence.
... satisfaction with current symptoms, although definitions of satisfaction showing that despite poor radiographic outcomes at a mean of 7.2 years after HHR, clinical outcomes were good. 32 Our study has several limitations. First, patients were given the option of completing the PRO survey electronically or in paper form. ...
Background
Humeral head resurfacing (HHR) has emerged as an alternative treatment for glenohumeral osteoarthritis. We investigated the outcomes of HHR using validated patient-reported outcome (PRO) measures.
Methods
A retrospective review was performed on 213 patients who underwent HHR. A PRO follow-up was performed by administering a questionnaire including the American Shoulder and Elbow Society (ASES) score, Brophy activity survey, short form of the Disabilities of the Arm, Shoulder and Hand (quickDASH) survey, and general shoulder function. PRO scores were stratified by comorbidities and complications.
Results
Survey responses were received from 106 patients (51%), with a mean follow-up of 5.6 ± 1.8 years (range: 9 months to 6.1 years). Preoperative comorbidities were associated with significantly higher quickDASH scores. Postoperative complications were associated with significantly higher rates of current pain, higher visual analog scale scores, night pain, lower subjective shoulder values, and lower ASES pain and total scores. No differences in patient satisfaction were identified between the cohorts with and without preoperative comorbidities and between the cohorts with and without postoperative complications.
Conclusion
In our cross-sectional analysis of mid- to long-term outcomes following HHR, preoperative comorbidities, or postoperative complications had no impact on patient-perceived postoperative satisfaction or most PROs. HHR is clinically viable in a wide variety of patients. Future work is necessary to compare the efficacy of HHR compared with more traditional total shoulder arthroplasty and stemmed hemiarthroplasty regarding long-term outcomes and appropriate indications.
... Ideal candidates for these procedures are young people with minimal glenoid wear and intact rotator cuffs. 63 Patients with avascular necrosis and maintained peripheral articular congruity are also candidates. 64 Levy et al reported on cementless surface replacement arthroplasty with 54 patients under the age of 50 years. ...
Chase B Ansok, Stephanie J Muh Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA Abstract: Glenohumeral osteoarthritis (OA) is defined as progressive loss of articular cartilage, resulting in bony erosion, pain, and decreased function. This article provides a gross overview of this disease, along with peer-reviewed research by experts in the field. The pathology, diagnosis, and classification of this condition have been well described. Treatment begins with non-operative measures, including oral and topical anti-inflammatory agents, physical therapy, and intra-articular injections of either a corticosteroid or a viscosupplementation agent. Operative treatment is based on the age and function of the affected patient, and treatment of young individuals with glenohumeral OA remains controversial. Various methods of surgical treatment, ranging from arthroscopy to resurfacing, are being evaluated. The roles of hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty are similarly reviewed with supporting data. Keywords: glenohumeral, osteoarthritis, hyaluronic acid, hemiarthroplasty, total shoulder arthroplasty
Introduction:
The treatment of shoulder osteoarthritis in the young patient remains challenging. The higher functional demands and higher expectations of the young patient cohort are often coupled with an increased failure and revision rate. Consequently, shoulder surgeons are faced with a unique challenge with implant selection. The aim of this study was to compare the survivorship and reasons for revision of the five classes of shoulder arthroplasty in patients aged <55 years with a primary diagnosis of osteoarthritis using data from a large national arthroplasty registry.
Methods:
The study population included all primary shoulder arthroplasty procedures undertaken for osteoarthritis in patients aged <55 years and reported to the registry between April 2004 to December 2020. Procedures were grouped into the class of total shoulder arthroplasty (TSA), hemiarthroplasty resurfacing (HRA), hemiarthroplasty stemmed metal head (HSMH), hemiarthroplasty stemmed pyrocarbon head (HSPH) and reverse total shoulder arthroplasty (RTSA). The outcome measure was the cumulative percent revision (CPR), which was defined using Kaplan-Meier estimates of survivorship to describe the time to the first revision. Hazard ratios (HR) from Cox proportional hazards models, adjusting for age and gender, were performed to compare the revision rates among groups RESULTS: There were 1,564 shoulder arthroplasty procedures in patients aged <55 years, of which 361 (23.1%) were HRA, 70 (4.5%) HSMH, 159 (10.2%) HSPH, 714 (45.7%) TSA and 260 (16.6%) RTSA (Table I). HRA had a higher rate of revision compared to RTSA after 1 year (1 year+ HR= 2.51 (95% CI 1.30, 4.83), p=0.005), with no difference prior to that time. HSMH also had a higher rate of revision compared to RTSA for the entire period (HR= 2.69 (95% CI 1.28, 5.63), p=0.008). There was no significant difference in the rate of revision for HSPH or TSA when they were compared to RTSA. Glenoid erosion was the most common cause of revision for HRA (28.6% of revisions) and for HSMH (50%). Instability/dislocation was the leading cause of revision for RTSA (41.7%), HSPH (28.6%) and for TSA the majority of revisions were for both instability/dislocation (20.6%) and loosening (18.6%).
Conclusion:
These results should be interpreted within the context of the lack availability of long-term data for RTSA and HSPH stems. RTSA outperforms all implants with regards to revision rates at mid-term follow-up. The high early dislocation rates associated with RTSA as well as the lack of revision options available for it indicate that careful selection of patients and a greater appreciation of anatomical risk factors is needed in future.
Level of evidence:
Level III; Retrospective Cohort Comparison using Large Database; Treatment Study; Keywords: Osteoarthritis, shoulder, arthroplasty, survivorship, young patients.
Glenohumeral arthritis can significantly impact quality of life, most notable in highly active patients. A linear approach to management based on age alone negates factors that impact patient goals such as pain control, joint function, and joint preservation. Diagnostics should use X-ray, computed tomography, and magnetic resonance imaging to provide information about severity of disease and inform treatment plans, including surgical approaches. Although surgical intervention in young adults has previously been controversial, after nonoperative interventions, such as medications, physical therapy, and intra-articular injections, have failed, many studies support arthroplasty to control pain and maximize function throughout their life span.
