Background: Both total shoulder arthroplasty and hemiarthroplasty
have been used commonly to treat severe osteoarthritis of the shoulder;
however, their effect on disease-specific quality-of-life outcome is unknown.
The purpose of this study was to compare the quality-of-life outcome following
hemiarthroplasty with that following total shoulder arthroplasty in patients
with osteoarthritis of the shoulder.
Methods: Forty-two patients with a diagnosis of osteoarthritis of
the shoulder were randomized to receive a hemiarthroplasty or a total shoulder
arthroplasty. One patient died, and all others were evaluated preoperatively
and at six weeks and three, six, twelve, eighteen, and twenty-four months
postoperatively with use of a standardized format including a disease-specific
quality-of-life measurement tool (Western Ontario Osteoarthritis of the
Shoulder [WOOS] index), general shoulder rating scales (University of
California at Los Angeles [UCLA] shoulder scale, Constant score, and American
Shoulder and Elbow Surgeons [ASES] evaluation form), general pain scales
(McGill pain score and visual analogue scale), and a global health measure
(Short Form-36 [SF-36]). When a patient required revision of a
hemiarthroplasty to a total shoulder arthroplasty, the last score before he or
she "crossed over" was used for the analysis.
Results: Significant improvements in disease-specific quality of
life were seen two years after both the total shoulder arthroplasties and the
hemiarthroplasties. There were no significant differences in quality of life
(WOOS score) between the group treated with total shoulder arthroplasty and
that treated with hemiarthroplasty (90.6 ± 13.2 and 81.5 ± 24.1
points, respectively; p = 0.18). The other outcome measures demonstrated
similar findings. Two patients in the hemiarthroplasty group crossed over to
the other group by undergoing a revision to a total shoulder arthroplasty
because of glenoid arthrosis.
Conclusions: Both total shoulder arthroplasty and hemiarthroplasty
improve disease-specific and general quality-of-life measurements. With the
small number of patients in our study, we found no significant differences in
these measurements between the two treatment groups.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.