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Cementless Humeral Resurfacing Arthroplasty in Active Patients Less Than Fifty-five Years of Age
David S. Bailie, MD1; Paulo J. Llinas, MD2; Todd S. Ellenbecker, DPT, MS, SCS, OCS, CSCS3
1 The Orthopedic Clinic Association, 9377 East Bell Road, Suite 231, Scottsdale, AZ 85260. E-mail address: david.bailie@dcranch.com
2 Fundacion Clinica Valle del Lili, Carrera 98 No. 18-49, P.O. Box 331 9090, Cali, Colombia. E-mail address: pllinas@fcvl.org
3 Physiotherapy Associates, Scottsdale Sports Clinic, 9917 North 95th Street, Scottsdale, AZ 85258. E-mail address: ellenbeckerpt@cox.net
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits (consulting fees associated with course instruction) of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Biomet Orthopedics). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.
Investigation performed at The Orthopedic Clinic Association, Scottsdale, Arizona

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jan 01;90(1):110-117. doi: 10.2106/JBJS.F.01552
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Background: Cementless humeral resurfacing arthroplasty is a bone-conserving arthroplasty option for patients with glenohumeral arthritis. It has been successful in the older patient population. However, data regarding the results of arthroplasty in younger, more active patients are lacking. We report the two-year results of this procedure in active patients who were less than fifty-five years of age.

Methods: We reviewed prospectively collected clinical data on a series of thirty-six patients under fifty-five years of age with end-stage glenohumeral arthrosis, but without osteonecrosis, who had undergone a cementless humeral resurfacing hemiarthroplasty performed by a single surgeon. All patients were followed for a minimum of two years. We assessed pain, function, and patient satisfaction and documented all complications. Radiographs were evaluated for implant loosening.

Results: The thirty-six patients had a mean age of 42.3 years and were followed for a mean of 38.1 months. Scores measured with a visual analog pain scale, the Single Assessment Numeric Evaluation (SANE) scale, and the American Shoulder and Elbow Surgeons (ASES) scale all improved significantly from preoperatively to two years postoperatively (p < 0.001). Complications included one traumatic subscapularis rupture at six weeks, three cases of arthrofibrosis, and one deep hematoma. No obvious radiographic evidence of loosening was noted at the time of the latest follow-up. One shoulder was converted to a stemmed total shoulder arthroplasty at twenty-four months because of pain, but the implant was not loose at the revision. The remaining thirty-five patients were satisfied with the outcome at the time of the latest follow-up and had returned to their desired activity.

Conclusions: Cementless humeral resurfacing arthroplasty is a viable treatment option for younger, active patients. Early results indicate that the desired function and pain relief can be expected. Implant loosening and glenoid wear do not appear to be concerns in the short term despite the high activity levels of many patients. Long-term follow-up is needed to determine if these results persist.

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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