Background: Active and young individuals with glenohumeral arthritis
who are treated with total glenohumeral arthroplasty are at risk for loosening
or wear of the prosthetic glenoid component. This study tests the hypothesis
that patients with severe glenohumeral arthritis have improvement in
self-assessed shoulder comfort and function at two to four years after
treatment with the combination of humeral hemiarthroplasty and concentric
glenoid reaming without tissue or prosthetic component interposition.
Methods: Thirty-seven consecutive patients (thirty-eight shoulders),
with a mean age of fifty-seven years, who were managed by one surgeon were
enrolled in this prospective study. The procedure consisted of an uncemented
humeral hemiarthroplasty combined with reaming of the glenoid to a diameter 2
mm larger than that of the prosthetic humeral head. The duration of follow-up
ranged from two to four years (average, 2.7 years) for thirty-five shoulders.
Self-assessed comfort and function was documented with use of the Simple
Shoulder Test, and radiographs were evaluated.
Results: Thirty-two shoulders demonstrated improved comfort and
function according to patient self-assessment, one demonstrated no change, and
two had worse function following the procedure. The total number of Simple
Shoulder Test functions that could be performed increased from 4.7 (of a
possible 12.0) before surgery to 9.4 at the time of the final follow-up. The
patients demonstrated significant improvement in ten of the twelve individual
functions of the Simple Shoulder Test (p < 0.022 to p < 0.00001). With
the numbers studied, gender, diagnosis, age, glenoid wear, and preoperative
glenoid erosion did not significantly affect final shoulder function or
overall improvement. The range of motion was significantly improved for all
individuals (p < 0.00001). Radiographically, twenty-two patients had a
joint space between the glenoid bone and the humeral prosthesis at the time of
final follow-up. These shoulders had significantly better function than those
without a preserved joint space (p < 0.017). There were no surgical
complications and no revisions to total shoulder arthroplasty.
Conclusions: At a minimum follow-up of two years, a selected series
of patients who had humeral hemiarthroplasty with concentric glenoid reaming
for the treatment of glenohumeral arthritis showed significant improvement in
self-assessed shoulder comfort and function. Further study, however, is needed
before routine application of this procedure can be recommended.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.