Hemiarthroplasty, TSA offer lasting pain relief, improved range of motion
Both hemiarthroplasty and total shoulder arthroplasty offered lasting pain relief, and range of motion was improved at the long-term follow-up; however, unsatisfactory Neer ratings were high, according to study results.
Seventy-eight Neer hemiarthroplasties (HAs) and 36 Neer total shoulder arthroplasties (TSAs) were performed by a single surgeon between Jan. 1, 1976, and Dec. 31, 1985, in patients 50 years of age or younger (mean age: 40 years). Of these procedures, 56 HAs and 19 TSAs had minimum 20-year follow-up or a follow-up until reoperation and were analyzed for clinical, radiographic and survivorship outcomes.
Researchers obtained pain, function and physical results using data from clinical visits, responses to letter questionnaires and phone interviews per their joint registry protocol, and patients’ total joints were examined at 1, 2 and 5 years postoperatively, as well as every 5 years thereafter. In addition, the researchers analyzed radiographs for preoperative and postoperative glenoid erosion (graded none to severe), pre- and postoperative glenohumeral subluxation (graded none to severe translation) and periprosthetic radiolucency (graded on five-point scale) between early follow-up and the final follow-up. Using clinical outcome values, the researchers determined Neer ratings.
Results showed mean pain score significantly decreased for HAs. Both mean abduction and external rotation also significantly improved, whereas internal rotation did not change. TSAs had similar pain, active abduction and external rotation improvements.
According to the researchers, 81% of patients overall rated their shoulders as being much better or better than their preoperative status. No significant differences were observed between HA and TSA with regard to modified Neer ratings.
Unsatisfactory ratings in both groups were due to reoperations, 25 of which were required for HAs and six were required for TSAs. Patients in the HA group also had unsatisfactory ratings with regard to limited motion, pain or dissatisfaction, whereas patients in the TSA group also had unsatisfactory ratings due to limited motion. The estimated 20-year survival rates for HA and TSA were 75.6% and 83.2%, respectively, according to the researchers.
Radiographic results showed 14 shoulder had recurrent subluxation, three shoulders had new glenoid erosion developed, 18 shoulders had progressive preexisting erosion and seven had severe erosion. Radiolucencies were observed in eight humeral components, the researchers reported. ‒ by Monica Jaramillo
Disclosures: Schoch reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.