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Treatment of Glenohumeral Arthritis with a Hemiarthroplasty: A Minimum Five-Year Follow-up Outcome Study
Michael A. Wirth, MD1; R. Stacy Tapscott, MD1; Carleton Southworth, MS2; Charles A. RockwoodJr., MD1
1 Health Science Center at San Antonio, University of Texas, Mail Code 7774, 7703 Floyd Curl Drive, San Antonio, TX 78284-7774. E-mail ad-dress for M.A. Wirth: wirth@uthscsa.edu. E-mail address for C.A. Rockwood Jr.: rockwood@uthscsa.edu
2 DePuy Orthopaedics, 700 Orthopaedic Drive, Warsaw, IN 46581-0988
View Disclosures and Other Information
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
Note: The authors thank Andrea Hicks for her assistance in the preparation of this work.
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from DePuy, a Johnson and Johnson Company. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy, a Johnson and Johnson company). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the University of Texas Health Science Center at San Antonio, San Antonio, Texas

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 May 01;88(5):964-973. doi: 10.2106/JBJS.D.03030
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Abstract

Background: 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.

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

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Joby John
    Posted on June 04, 2006
    Treatment of Glenohumeral Arthritis with a Hemiarthroplasty: A Minimum Five-Year Follow-up Outcome S
    Robert Jones Agnes Hunt Hospital, Oswestry, ENGLAND

    To The Editor:

    I read with great interest the follow-up of hemiarthroplasty of the shoulder in osteoarthritis by Wirth, et al(1). The function and survivorship in these patients certainly emphasises that hemiarthroplasty is an adequate procedure for osteoarthritis in selected patients.

    The authors have defined adequate soft tissue release and explained their method for choosing a center point for the glenoid even in the presence of erosion, which is very useful information for shoulder arthroplasty surgeons.

    It was interesting to read that the results in this series did not seem to be affected by the presence of rotator cuff tears. The subgroup of patients who had a nonconcentric glenoid and persistent luxations seemed to have a worse functional score. We would be keen to know if this group had a higher rate of glenoid erosion on follow-up as might be expected.

    It was interesting to note that the subscapularis deficiencies were a result of muscle atrophy even though there was no direct damage to the muscle as the lesser tuberosity was osteotomised and presumably healed uneventfully. Assuming that the possibility of damage to the nerve supply of the subscapularis was unlikely, I would pose the question of what was the reason for subscapularis atrophy?

    Reference:

    1. Wirth MA, Tapscott RS, Southworth C, Rockwood CA. Treatment of glenohumeral arthritis with a hemiarthroplasty: a minimum five-year follow-up outcome study. J Bone Joint Surg Am. 2006; 964-973.

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