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.
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
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.
Shoulder hemiarthroplasty provides sustained good-to-excellent pain relief
and functional improvement at five to ten years postoperatively in carefully
selected patients with osteoarthritis.