Shoulder arthroplasty has been proven to be clinically useful in patients with glenohumeral osteoarthritis during the past 6 decades.1 Over time, many designs of prosthesis have been used. Copeland popularized the resurfacing prosthesis in the 1980s,2,3 which required metal caps to be secured in place by a short central peg. The suggested advantages of this prosthesis include the preservation of the native head-shaft angle and center of rotation. Additionally, minimal resection of the humeral head is required to fit the prosthesis, which results in shorter operative time. Low prevalence of periprosthetic fractures is seen without the stress riser effect of a stem.4,5 Nevertheless, anatomical restoration is difficult because the humeral head is easily oversized and the design of the prosthesis may not replicate the native humeral head.6–8 Follow-up studies show positive functional and patient-reported results.4,5,9–13 Compared with conventional hemiarthroplasties, the resurfacing prosthesis has equivalent results; however, the revision rate is higher.14–17
Revision of conventional shoulder hemiarthroplasty is a time-consuming and difficult procedure in which extraction of the stem is prone to perioperative complications.18,19 Additionally, results are disappointing; up to 57% of the patients report unsatisfactory outcome measures and up to 27% need re-revision in 10 years.19,20 In case of revision of a resurfacing prosthesis, however, the removal of the implant is easily facilitated. Perioperative complications are rare, bone graft to compensate for lost humeral bone stock is seldom required, and less surgical time is needed.18,20 However, there are limited published data about the results of this revision, and to the authors' knowledge, follow-up has been described in only 3 series of patients with conflicting results.18,20–22
Therefore, the aim of this study was to report the clinical and functional outcomes of revision from the uncemented Global CAP resurfacing prosthesis (DePuy, Warsaw, Indiana) to a total shoulder prosthesis (TSA) or a reverse shoulder prosthesis (RSA). In addition, the authors performed a survivorship analysis and compared the baseline characteristics of the Global CAP revision and nonrevision groups to determine factors predictive of revision.
Materials and Methods
This study was performed as an extension to the ongoing follow-up study of patients treated with the uncemented Global CAP resurfacing shoulder prosthesis.10,17,23 The study received institutional review board approval, and all patients provided written informed consent.
Adult patients with osteoarthritis for whom conservative treatment failed were enrolled in this study and treated with un-cemented Global CAP resurfacing hemiarthroplasty between January 2007 and December 2009. This cohort consisted of 36 women and 12 men, with a mean age of 66 years (range, 54–84 years). The 48 shoulders (46 patients) that were included had intact rotator cuff, sufficient (>60%) bone stock of the proximal humerus, and type A1, A2, or B1 glenoid (Walch classification24) as assessed on radiographs and magnetic resonance imaging. Excluded patients had severe fatty infiltration (Goutallier grade 4)25 or paresis of rotator cuff muscles, wound healing or neuromuscular pathologies, or active infections.10,17
At a mean follow-up of 4.5 years, 11 patients (23%) had undergone revision surgery. Pain and poor function were caused by glenoid erosion in 4 patients (36%). Undefined pain and loss of function were found in 2 (18%) patients. Cuff arthropathy was found in 2 patients (18%), with 1 patient's prosthesis having anterior subluxations after a failed subscapularis tendon repair. Arthrofibrosis and painful glenoid without erosion were reasons for revision in 2 other patients. One patient (9%) had low-grade infection without loosening of the prosthesis; cultures showed Pantoea agglomerans, Staphylococcus epidermidis, and Propionibacterium acnes.23 Total shoulder arthroplasty was used in 8 patients. Three patients received a RSA, of whom 2 patients had an insufficient rotator cuff and 1 had excessive glenoid erosion (Figure 1, Table 1).
Anteroposterior radiographs of left shoulders with Global CAP (DePuy, Warsaw, Indiana) resurfacing prosthesis before revision (A), T.E.S.S. Total Shoulder Arthroplasty (Biomet, Valence, France) (B), Global AP Total Shoulder Arthroplasty (DePuy Synthes, Warsaw, Indiana) (C), and Delta Xtend Reverse Shoulder Arthroplasty (DePuy Synthes) (D).
Characteristics of Revision Patient Population (n=11)
During the revision procedures, the prostheses were easily removed from the proximal humerus. The bone density underneath the prosthesis was significantly decreased in all cases, although none of the prostheses were loosened. No revision required humeral osteotomy or humeral bone allograft. No perioperative complications occurred.
Rehabilitation consisted of pendulum exercises of the arm during the first 2 weeks. A period of 4 weeks with active assisted and passive motion within 90° of anteflexion and abduction and maximum of 30° of external rotation was advised for TSA patients. A sling was given for support during the first 6 weeks. Restricted range of motion and use of the supportive sling in RSA rehabilitation lasted 2 weeks. Additional physiotherapy was advised for 3 to 6 months for both TSA and RSA.
Pre- and post-revision assessments were performed at the outpatient clinic. The Constant–Murley score was used as a guideline for shoulder function and was adjusted for sex and age.26 Secondary outcomes included pain measured by the visual analog scale27 and Short Form-1228 and shoulder function measured by the Dutch Simple Shoulder Test.29 Initial pre-resurfacing data were retrieved from the authors' study database. Baseline measurements of successful and revised Global CAP resurfacing prostheses were compared. The last orthopedic follow-up and date of death or revision were collected from all patient files to analyze the survival.
Statistical analysis was performed with SPSS version 20.0 software (IBM, Armonk, New York). Nominal and ordinal outcomes were presented with frequencies and corresponding percentages. Continuous variables were presented as means and standard deviations or 95% confidence intervals. Pre- and postoperative pain, Constant–Murley, Short Form-12, and Dutch Simple Shoulder Test scores, and range of motion and strength were compared using paired t tests. Baseline characteristics of the patients with and without revision surgery were compared. For categorical variables, chi-square tests were performed; continuous variables were analyzed using t tests or Mann– Whitney U tests in case of non-normality. Kaplan–Meier curves were used for survival analysis, and a log-rank test was performed to compare survival of the prosthesis between male and female patients. Revision was defined as the endpoint, and dates of death or last follow-up were used as censuring dates. P<.05 was considered statistically significant.
Post-revision assessments were achieved for 10 of the 11 revision patients. The 1 missing patient had emigrated and had revision surgery abroad. This patient did not reply to the survey. Assessments were made at a mean of 42 months (minimum follow-up, 21 months; maximum follow-up, 74 months; SD, 15.9 months) and showed good clinical and patient-reported outcome measures. The Constant–Murley score improved significantly, with a mean of 26 points (95% confidence interval, 9.6–43.0), and all patients scored above 80 points. Of 10 patients, 8 (80%) had no pain according to visual analog scale score. The partial Constant–Murley score for internal rotation resulted in a significant improvement from a median of 4 (reach to lumbosacral; inter-quartile range, 4–4) to 7 (reach between L3 and T12; interquartile range, 5.5–8) (P=.03). However, no significant improvement was observed for external rotation (P=.07). Both Dutch Simple Shoulder Test and Short Form-12 scores were significantly improved (Table 2).
Comparison of Assessments Before and After Revision
Baseline characteristics of patients with and without revision are listed in Table 3 and Table 4. Goutallier et al25 grade fattening of the supraspinatus muscle was assessed on magnetic resonance imaging and was significantly higher in the non-revision CAP group (P<.01). No other significant preoperative differences were found between the 2 groups. Regression analyses showed a significant correlation between Constant–Murley score and sex (P<.01); therefore, the comparison between the revision and nonrevision group was corrected for sex.
Baseline Characteristics of Patients With and Without Revision
Baseline Radiological Assessment of Patients With and Without Revision
In total, the 5-year survival of the Global CAP resurfacing prosthesis was 82.6% (95% confidence interval, 71.6%–93.6%). No significant difference was found between male and female patients (P=.40). Five-year survival was 85.3% (95% confidence interval, 73.3%–97.3%) for women and 75% (95% confidence interval, 50.5%–99.5%) for men. The Kaplan–Meier curves for all patients and for sex are shown in Figure 2.
Kaplan–Meier survival analysis for total group (A) and by sex (B). Five-year cut of time marked with vertical line. Abbreviations: F, female; M, male.
There were no re-revisions.
The main finding of this study was the good outcome at midterm follow-up of shoulder arthroplasty after revision from the uncemented Global CAP resurfacing prosthesis. Comparable, good clinical outcomes were reported by Natera et al20 in 18 revisions of the Copeland resurfacing prosthesis. In contrast, Streubel et al21 found that only 4 of 11 (36%) patients had satisfactory results based on the modified Neer score. One re-revision (9%) had to be performed in their series.21 In the latest study, by Rasmussen et al,22 unsatisfactory outcomes were reported by 41% (n=33) of the 80 shoulder resurfacing revision patients from the Danish national register.
These various results could be explained by the presence of confounding variables such as the experience of the surgeon, age, prior surgery, differences between implants used, and underlying original pathology.21 Surgical volume has proven to be related to the outcome of shoulder prostheses.30 The implantation rates of TSA and RSA are rising1,31; therefore, surgical skill and experience should increase proportionately.
High-volume orthopedic surgeons (ie, more than 8 shoulder arthroplasties per year30) performed the revisions at the authors' institutions. The authors used 3 different prosthesis designs to revise the failed CAP resurfacing prosthesis (Table 1). The surgeons have extensive experience with these designs; the same prostheses used for primary stemmed TSA and RSA were used for the revision of the CAP prosthesis during this study. In contrast, Natera et al20 successfully used 1 specific type of RSA and reported that RSA was the best option in revision situations. There is limited evidence regarding the role of surgeon experience and prosthesis design in the outcome of revision surgery. The best prosthesis design to use for revision has yet to be determined. In the current authors' opinion, surgeon experience with the specific prosthesis design is most valuable.
For the treatment of glenohumeral osteoarthritis, TSA is the gold standard.32–35 However, the authors believe that a hemiprosthesis such as a resurfacing implant is still a valid treatment option in selected patients. The limited survival of the glenoid component in TSA is troubling. At midterm follow-up, the rate of glenoid loosening has been reported to be 39%.4,36–43 Factors such as rotator cuff failure, glenoid component malposition, and instability can lead to glenoid component loosening and failure.38,42,44
Young patients have been shown to have higher demands of their shoulder prostheses, and optimal shoulder function is needed for labor and physical activities.4,11 Patient-reported outcome measures are likely to be related to these demands.45 Hemiarthroplasties are prone to fail in young patients. The average age in the current series was 66 years; this older age could have been favorable for the outcomes.
Streubel et al21 stressed the importance of exposure in their revision surgeries when prior preservation of the rotator cuff was done. Owing to excessive scarring, a different approach was needed in 4 of their 11 cases. In the current study, only 1 patient had prior surgery (subscapularis tendon repair). Owing to the low prevalence of prior surgeries in this series, soft tissue damage and scarring were minimal. The extraction of the failed CAP prosthesis was easily accomplished after exposing the glenohumeral joint. During revision surgery, humeral osteotomy or humeral bone allograft was not necessary in all cases; this is in contrast to studies by Al-Hadithy et al46 and Alizadehkhaiyat et al.47 The current study did not show perioperative complications such as humeral fractures. With these advantages, Cisneros et al18 found that more than an hour of time was spared compared with revision of stemmed hemiarthroplasty, which is likely to minimize the perioperative complication hazard.
In the current study, the authors found a 5-year survival rate of 82.6%. Lebon et al48 found only a 41% survival rate of resurfacing prostheses at 5.5-year follow-up in 37 patients, which was significantly poorer than the 0 revisions in their stemmed hemiarthroplasty group. Levy et al11 reported a better 5-year survival rate of 97%. Clearly higher revision rates were reported beyond 5-year follow-up.11,31,48
There is certainly a discrepancy in the literature regarding the percentage of revision due to glenoid erosion and pain in resurfacing prostheses.11,47–52 Levy et al49 and Mullett et al50 reported 3% and 5% revision rates, respectively, at mid-term follow-up. Alizadehkhaiyat et al47 and Smith et al52 reported 21% and 22% revision rates at short-term and midterm follow-up, respectively. The current authors found a similar revision rate (23%) despite their careful inclusion criteria: glenohumeral osteoarthritis, intact rotator cuff, and glenoid type A1, A2, or B1.
In their initial series, 42% of the male and 17% of the female patients had a revision. However, a nonsignificant P value was found when comparing the sex-specific survival curves. Additionally, similar results were presented in the 2015 annual report of the Australian Orthopaedic Association, indicating no sex-specific differences in revision rate in 92 patients.16 A decrease in the use of resurfacing prostheses has been observed since 2006,31 with a probable decrease in surgical skill. Developments in resurfacing are therefore likely to diminish.
Although results varied, the indications for revision were comparable in all revision series the current authors reviewed.17,18,20–22 Hartel et al,53 Sajadi et al,54 and Dines et al55 showed inferior outcomes if revisions of hemiarthroplasty were due to soft tissue pathologies compared with glenoid erosion or component failure. Regarding resurfacing prostheses, the effect of indication for revision has not been investigated. However, glenoid erosion is a major concern in resurfacing hemiarthroplasty.56 Regarding the numbers available in their baseline comparison, the current authors conversely found significant lower Goutallier grades in the revision group, suggesting that good muscle condition could be a risk factor for early revision. This in contrast to Herschel et al,57 who found fatty infiltration of the rotator cuff to be a risk factor for glenoid erosion in hemiarthroplasty.
The CAP resurfacing prosthesis did not show signs of loosening on radiographs, and no loose prostheses were found during revision. However, perioperative observations indicated that there was significantly reduced bone density underneath the CAP prosthesis. These findings are similar to those described by Schmidutz et al,58 who reported that despite clear signs of stress shielding, adequate ingrowth of bone was observed to secure good stability of the prosthesis. The bone quality of the proximal humerus was not affected. Even a stemless prosthesis such as the T.E.S.S. (Biomet, Valence, France) could be firmly secured after the removal of the humeral head re-surfacing arthroplasty.
A limitation of this study was the small sample. Although a CAP resurfacing replacement was implanted in 48 shoulders, only 11 were revised and therefore available for this study. Another limitation of this study was the lack of a control group. A stemmed control group or primary TSA group like the studies of Natera et al20 and Rasmussen et al22 would yield valuable information and opportunities for comparison. Unfortunately, such data were not available. Despite the low therapeutic level of this study, it involved, to the authors' knowledge, the only cohort of revisions of this specific prosthesis described in the literature and showed good results.
At midterm follow-up, patient-reported outcome measures were satisfying after revision of the uncemented Global CAP resurfacing hemiprosthesis to TSA or RSA. Despite the limited, conflicting literature on this subject, the data of this study support the authors' opinion that TSA or RSA is a viable option when a re-surfacing hemiarthroplasty has failed.
- Singh JA, Sperling J, Buchbinder R, McMaken K. Surgery for shoulder osteoarthritis: a Cochrane systematic review. J Rheumatol. 2011;38(4):598–605. doi:10.3899/jrheum.101008 [CrossRef]
- Levy O, Copeland SA. Cementless surface replacement arthroplasty of the shoulder: 5- to 10-year results with the Copeland mark-2 prosthesis. J Bone Joint Surg Br. 2001;83(2):213–221. doi:10.1302/0301-620X.83B2.11238 [CrossRef]
- Burgess DL, McGrath MS, Bonutti PM, Marker DR, Delanois RE, Mont MA. Shoulder resurfacing. J Bone Joint Surg Am. 2009;91(5):1228–1238. doi:10.2106/JBJS.H.01082 [CrossRef]
- Bailie DS. Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age. J Bone Joint Surg Am. 2008;90(1):110–117. doi:10.2106/JBJS.F.01552 [CrossRef]
- Pritchett JW. Long-term results and patient satisfaction after shoulder resurfacing. J Shoulder Elbow Surg. 2011;20(5):771–777. doi:10.1016/j.jse.2010.08.014 [CrossRef]
- Mansat P, Coutié AS, Bonnevialle N, Rongières M, Mansat M, Bonnevialle P. Re-surfacing humeral prosthesis: do we really reconstruct the anatomy?J Shoulder Elbow Surg.2013;22(5):612–619. doi:10.1016/j.jse.2012.07.014 [CrossRef]
- Chen EJ, Simovitch R, Savoie F, Noel CR. Assessment of the anatomic neck as an accurate landmark for humeral head resurfacing implant height placement. Bull Hosp Jt Dis (2013). 2015;73(suppl 1):S28–S32.
- Mechlenburg I, Amstrup A, Klebe T, Jacobsen SS, Teichert G, Stilling M. The Copeland resurfacing humeral head implant does not restore humeral head anatomy: a retrospective study. Arch Orthop Trauma Surg. 2013;133(5):615–619. doi:10.1007/s00402-013-1715-8 [CrossRef]
- Rasmussen JV, Olsen BS, Sorensen AK, Hróbjartsson A, Brorson S. Resurfacing hemiarthroplasty compared to stemmed hemiarthroplasty for glenohumeral osteoarthritis: a randomised clinical trial. Int Orthop. 2015;39(2):263–269. doi:10.1007/s00264-014-2505-9 [CrossRef]
- Geervliet P, van den Bekerom M, Spruyt P, Curvers M, Visser C, van Noort A. Short-term results of the global C.A.P. uncemented resurfacing shoulder prosthesis. Orthopedics. 2014;37(1):42–47. doi:10.3928/01477447-20131219-07 [CrossRef]
- Levy O, Tsvieli O, Merchant J, et al. Surface replacement arthroplasty for glenohumeral arthropathy in patients aged younger than fifty years: results after a minimum ten-year follow-up. J Shoulder Elbow Surg. 2015;24(7):1049–1060. doi:10.1016/j.jse.2014.11.035 [CrossRef]
- Rai P, Davies O, Wand J, Bigsby E. Long-term follow-up of the Copeland mark III shoulder resurfacing hemiarthroplasty. J Orthop. 2016;13(1):52–56. doi:10.1016/j.jor.2015.09.003 [CrossRef]
- Voorde PC, Rasmussen JV, Olsen BS, Brorson S. Resurfacing shoulder arthroplasty for the treatment of severe rheumatoid arthritis: outcome in 167 patients from the Danish Shoulder Registry. Acta Orthop. 2015;86(3):293–297. doi:10.3109/17453674.2015.1018761 [CrossRef]
- Fevang BTS, Lygre SHL, Bertelsen G, Skredderstuen A, Havelin LI, Furnes O. Pain and function in eight hundred and fifty nine patients comparing shoulder hemiprostheses, resurfacing prostheses, reversed total and conventional total prostheses. Int Orthop. 2013;37(1):59–66. doi:10.1007/s00264-012-1722-3 [CrossRef]
- Rasmussen JV, Polk A, Sorensen AK, Olsen BS, Brorson S. Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder: 837 operations reported to the Danish shoulder arthroplasty registry. Bone Joint J. 2014;96(4):519–525. doi:10.1302/0301-620X.96B4.31850 [CrossRef]
- Australian Orthopaedic Association National Joint Replacement Registry. Annual report of the Australian Orthopaedic Association: demographics and outcome of shoulder arthroplasty. https://aoanjrr.sahmri.com/en/annual-reports-2017/supplementary.
- Geervliet PC, van den Bekerom MPJ, Spruyt P, Curvers M, van Noort A, Visser CPJ. Outcome and revision rate of uncemented glenohumeral resurfacing (C.A.P.) after 5–8 years. Arch Orthop Trauma Surg. 2017;137(6):771–778. doi:10.1007/s00402-017-2688-9 [CrossRef]
- Cisneros LG, Atoun E, Abraham R, Tsvieli O, Bruguera J, Levy O. Revision shoulder arthroplasty: does the stem really matter?J Shoulder Elbow Surg.2016;25(5):747–755. doi:10.1016/j.jse.2015.10.007 [CrossRef]
- Sassoon AA, Rhee PC, Schleck CD, Harmsen WS, Sperling JW, Cofield RH. Revision total shoulder arthroplasty for painful glenoid arthrosis after humeral head replacement: the nontraumatic shoulder. J Shoulder Elbow Surg. 2012;21(11):1484–1491. doi:10.1016/j.jse.2011.11.028 [CrossRef]
- Natera L, Bruguera J, Atoun E, Levy O. Revision shoulder arthroplasty from resurfacing to non-cemented short-stem reverse prosthesis. Rev Esp Cir Ortop Traumatol. 2016;60(3):175–183.
- Streubel PN, Simone JP, Cofield RH, Sperling JW. Revision of failed humeral head resurfacing arthroplasty. Int J Shoulder Surg. 2016;10(1):21–27. doi:10.4103/0973-6042.174514 [CrossRef]
- Rasmussen JV, Olsen BS, Al-Hamdani A, Brorson S. Outcome of revision shoulder arthroplasty after resurfacing hemiarthroplasty in patients with glenohumeral osteoarthritis. J Bone Joint Surg Am. 2016;98(19):1631–1637. doi:10.2106/JBJS.15.00934 [CrossRef]
- Engelsma Y, Buma P, Geervliet PC, Noort AV. Septic failure is not a septic loosening: a case report of a failed shoulder prosthesis. Int J Shoulder Surg. 2012;6(4):121–125. doi:10.4103/0973-6042.106225 [CrossRef]
- Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999;14(6):756–760. doi:10.1016/S0883-5403(99)90232-2 [CrossRef]
- Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty infiltration of disrupted rotator cuff muscles. Rev Rhum Engl Ed. 1995;62(6):415–422.
- Constant CR, Gerber C, Emery RJ, Søjbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008;17(2):355–361. doi:10.1016/j.jse.2007.06.022 [CrossRef]
- Richards RR, An KN, Bigliani LU, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994;3(6):347–352. doi:10.1016/S1058-2746(09)80019-0 [CrossRef]
- Gandek B, Ware JE, Aaronson NK, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51(11):1171–1178. doi:10.1016/S0895-4356(98)00109-7 [CrossRef]
- van Kampen DA, van Beers LW, Scholtes VA, Terwee CB, Willems WJ. Validation of the Dutch version of the Simple Shoulder Test. J Shoulder Elbow Surg. 2012;21(6):808–814. doi:10.1016/j.jse.2011.09.026 [CrossRef]
- Hammond JW, Queale WS, Kim TK, McFarland EG. Surgeon experience and clinical and economic outcomes for shoulder arthroplasty. J Bone Joint Surgery Am. 2003;85(12):2318–2324. doi:10.2106/00004623-200312000-00008 [CrossRef]
- Fevang BT, Nystad TW, Skredderstuen A, Furnes ON, Havelin LI. Improved survival for anatomic total shoulder prostheses. Acta Orthop. 2015;86(1):63–70. doi:10.3109/17453674.2014.984113 [CrossRef]
- van den Bekerom MP, Geervliet PC, Somford MP, van den Borne MP, Boer R. Total shoulder arthroplasty versus hemiarthroplasty for glenohumeral arthritis: a systematic review of the literature at long-term follow-up. Int J Shoulder Surg. 2013;7(3):110–115. doi:10.4103/0973-6042.118915 [CrossRef]
- Bryant D, Litchfield R, Sandow M, Gartsman GM, Guyatt G, Kirkley A. A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. J Bone Joint Surg Am. 2005;87(9):1947–1956. doi:10.2106/JBJS.D.02854 [CrossRef]
- Duan X, Zhang W, Dong X, et al. Total shoulder arthroplasty versus hemiarthroplasty in patients with shoulder osteoarthritis: a meta-analysis of randomized controlled trials. Semin Arthritis Rheum. 2013;43(3):297–302. doi:10.1016/j.semarthrit.2013.04.002 [CrossRef]
- Jain NB, Hocker S, Pietrobon R, Guller U, Bathia N, Higgins LD. Total arthroplasty versus hemiarthroplasty for glenohumeral osteoarthritis: role of provider volume. J Shoulder Elbow Surg. 2005;14(4):361–367. doi:10.1016/j.jse.2004.10.007 [CrossRef]
- Torchia ME, Cofield RH, Settergren CR. Total shoulder arthroplasty with the Neer prosthesis: long-term results. J Shoulder Elbow Surg. 1997;6(6):495–505. doi:10.1016/S1058-2746(97)90081-1 [CrossRef]
- Hawkins RJ, Greis PE, Bonutti PM. Treatment of symptomatic glenoid loosening following unconstrained shoulder arthroplasty. Orthopedics. 1999;22(2):229–234.
- Hasan SS, Leith JM, Campbell B, Kapil R, Smith KL, Matsen FA III, . Characteristics of unsatisfactory shoulder arthroplasties. J Shoulder Elbow Surg. 2002;11(5):431–441. doi:10.1067/mse.2002.125806 [CrossRef]
- Bohsali KI, Wirth MA, Rockwood CA Jr, . Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88(10):2279–2292.
- Bishop JY, Flatow EL. Humeral head replacement versus total shoulder arthroplasty: clinical outcomes. A review. J Shoulder Elbow Surg. 2005;14(suppl 1):S141–S146. doi:10.1016/j.jse.2004.09.027 [CrossRef]
- Antuna SA, Sperling JW, Cofield RH, Rowland CM. Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg. 2001;10(3):217–224. doi:10.1067/mse.2001.113961 [CrossRef]
- Melis B, Bonnevialle N, Neyton L, et al. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?J Shoulder Elbow Surg.2012;21(3):342–349. doi:10.1016/j.jse.2011.05.021 [CrossRef]
- Bonnevialle N, Melis B, Neyton L, et al. Aseptic glenoid loosening or failure in total shoulder arthroplasty: revision with glenoid reimplantation. J Shoulder Elbow Surg. 2013;22(6):745–751. doi:10.1016/j.jse.2012.08.009 [CrossRef]
- Bohsali KI, Bois AJ, Wirth MA. Complications of shoulder arthroplasty. J Bone Joint Surg Am. 2017;99(3):256–269. doi:10.2106/JBJS.16.00935 [CrossRef]
- Johnson MH, Paxton ES, Green A. Shoulder arthroplasty options in young (<50 years old) patients: review of current concepts. J Shoulder Elbow Surg. 2015;24(2):317–325. doi:10.1016/j.jse.2014.09.029 [CrossRef]
- Al-Hadithy N, Furness N, Patel R, et al. Cementless surface replacement hemiarthroplasty for primary glenohumeral osteoarthritis: results of over 5-year follow-up in patients with or without rotator cuff deficiency. Shoulder Elbow. 2015;7(4):237–243. doi:10.1177/1758573215573456 [CrossRef]
- Alizadehkhaiyat O, Kyriakos A, Singer MS, Frostick SP. Outcome of Copeland shoulder resurfacing arthroplasty with a 4-year mean follow-up. J Shoulder Elbow Surg. 2013;22(10):1352–1358. doi:10.1016/j.jse.2013.01.027 [CrossRef]
- Lebon J, Delclaux S, Bonnevialle N, Rongières M, Bonnevialle P, Mansat P. Stemmed hemiarthroplasty versus resurfacing in primary shoulder osteoarthritis: a single-center retrospective series of 78 patients. Orthop Traumatol Surg Res. 2014;100(suppl 6):327S–332S. doi:10.1016/j.otsr.2014.05.012 [CrossRef]
- Levy O, Funk L, Sforza G, Copeland SA. Copeland surface replacement arthroplasty of the shoulder in rheumatoid arthritis. J Bone Joint Surg Am. 2004;86(3):512–518. doi:10.2106/00004623-200403000-00008 [CrossRef]
- Mullett H, Levy O, Raj D, Even T, Abraham R, Copeland SA. Copeland surface replacement of the shoulder: results of an hydroxyapatite-coated cementless implant in patients over 80 years of age. J Bone Joint Surg Br. 2007;89(11):1466–1469. doi:10.1302/0301-620X.89B11.18850 [CrossRef]
- Al-Hadithy N, Domos P, Sewell MD, Naleem A, Papanna MC, Pandit R. Cementless surface replacement arthroplasty of the shoulder for osteoarthritis: results of fifty Mark III Copeland prosthesis from an independent center with four-year mean follow-up. J Shoulder Elbow Surg. 2012;21(12):1776–1781. doi:10.1016/j.jse.2012.01.024 [CrossRef]
- Smith T, Gettmann A, Wellmann M, Pastor F, Struck M. Humeral surface replacement for osteoarthritis. Acta Orthop. 2013;84(5):468–472. doi:10.3109/17453674.2013.838658 [CrossRef]
- Hartel BP, Alta TD, Sewnath ME, Willems WJ. Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery. Int J Shoulder Surg. 2015;9(3):69–73. doi:10.4103/0973-6042.161426 [CrossRef]
- Sajadi KR, Kwon YW, Zuckerman JD. Revision shoulder arthroplasty: an analysis of indications and outcomes. J Shoulder Elbow Surg. 2010;19(2):308–313. doi:10.1016/j.jse.2009.05.016 [CrossRef]
- Dines JS, Fealy S, Strauss EJ, et al. Outcomes analysis of revision total shoulder replacement. J Bone Joint Surg Am. 2006;88(7):1494–1500. doi:10.2106/JBJS.D.02946 [CrossRef]
- Soudy K, Szymanski C, Lalanne C, et al. Results and limitations of humeral head resurfacing: 105 cases at a mean follow-up of 5 years. Orthop Traumatol Surg Res. 2017;103(3):415–420. doi:10.1016/j.otsr.2016.12.015 [CrossRef]
- Herschel R, Wieser K, Morrey ME, Ramos CH, Gerber C, Meyer DC. Risk factors for glenoid erosion in patients with shoulder hemiarthroplasty: an analysis of 118 cases. J Shoulder Elbow Surg. 2017;26(2):246–252. doi:10.1016/j.jse.2016.06.004 [CrossRef]
- Schmidutz F, Sprecher CM, Milz S, Gohlke F, Hertel R, Braunstein V. Resurfacing of the humeral head: an analysis of the bone stock and osseous integration under the implant. J Orthop Res. 2015;33(9):1382–1390. doi:10.1002/jor.22902 [CrossRef]
Characteristics of Revision Patient Population (n=11)
|Age at revision, mean±SD, y||69±6.2|
|Survival, mean±SD, mo||54±15.6|
|Sex, % male (male/female, No.)||45.5% (5/6)|
| Dominant, % right (right/left, No.)||81% (9/2)|
| Operation, % right (right/left, No.)||45.5% (5/6)|
|Reason for revision, No.|
| Glenoid erosion||4|
| Pain and rROM||2|
| Cuff arthropathy||2|
|Revision prosthesis, No.|
| Global APa||3|
| Delta Xtendc||3|
Comparison of Assessments Before and After Revision
|Before Revision||After Revision|
|Constant–Murley score, points||67.1±26.0||96.1±7.2||<.01|
|Visual analog scale score, points||54.3±24.4||5.0±10.8||<.01|
|Dutch Simple Shoulder Test score, points||43.9±28.9||84.2±13.3||<.01|
|Short Form-12 physical component score, points||36.7±9.1||43.9±12.3||.02|
|Short Form-12 mental component score, points||42.6±9.9||55.5±10.6||<.01|
Baseline Characteristics of Patients With and Without Revision
|Characteristic||Revision (n=11)||No Revision (n=37)||P||Significant Correlationa|
|Sex, % male (male/female, No.)||45.5% (5/6)||18.9% (7/30)||.11b||No|
|Age, mean±SD, y||62.9±6.2||66.6±7.8||.16||No|
|Constant–Murley score, mean±SD, points||46.3±18.5||46.8±16.9||.93||.42|
|Visual analog scale score, mean±SD, points||62.0±15.1||65.2±18.2||.60||.73|
|Short Form-12 mental component score, mean±SD, points||51.7±10.8||48.1±12.3||.39||.58|
|Short Form-12 physical component score, mean±SD, points||32.2±6.5||35.5±7.9||.22||.20|
|Dutch Simple Shoulder Test score, mean±SD, points||27.6±27.5||20.0±21.3||.34||.57|
Baseline Radiologicala Assessment of Patients With and Without Revision
|Revision (n=11)||No Revision (n=37)|
| None||9 (82)||4 (11)|
| Grade 1||2 (18)||26 (70)|
| Grade 2||0 (0)||6 (16)|
| Grade 3||0 (0)||1 (3)|
| A1||9 (82)||17 (46)|
| A2||1 (9)||14 (38)|
| B1||1 (9)||6 (16)|
| None||1 (9)||1 (3)|
| Little||6 (55)||14 (38)|
| Moderate||4 (36)||19 (51)|
| Severe||0 (0)||3 (8)|
| Yes (<1 cm)||0 (0)||4 (11)|
| No||11 (100)||33 (89)|
| Yes||5 (45)||6 (16)|
| No||6 (55)||31 (84)|