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Abstract

Background: While there has been some renewed interest in the use of hemiarthroplasty for osteoarthritis of the shoulder, there is little information available concerning the long term results of this procedure. Therefore, the purpose of this study was to determine the results, risk factors for an unsatisfactory outcome and rates of failure for the treatment of osteoarthritis of the shoulder with hemiarthroplasty. Methods: Between 1978 and 1997, sixty humeral head replacements were performed at our institution for the primary diagnosis of osteoarthritis. Patients with any historical or radiographic evidence of inflammatory arthritis, post traumatic arthritis, prior instability surgery, avascular necrosis, cuff tear arthropathy, intraoperative unrepairable rotator cuff tears, and hemophilia were excluded from the study. 51 humeral head replacements in 49 patients performed for the diagnosis of end stage osteoarthritis with complete preoperative evaluation, operative records, and minimum 5-year follow-up (mean 136 months) or follow-up until revision were included in the study. Seven patients died with less than five year follow-up and 1 patient (2 shoulders) was lost to follow-up. All 60 shoulders were included in the survival analysis. A retrospective chart review and radiographic analysis was performed. Results: There was significant long term pain relief (P<.0001), improvement in active abduction (P<.0001), internal rotation (P<.0242), and external rotation (P<.0001) with humeral head replacement. According to a modified Neer result rating, there were 10 excellent (20%), 20 satisfactory (39%), and 21 unsatisfactory results (41%). Ten of fifty-one shoulders (20%) underwent revision surgery, nine of ten for painful glenoid arthritis. Complete pre-operative, immediate post-operative, and most recent follow-up radiographs were available in 39 patients with a mean follow-up of 128 months. Humeral periprosthetic lucency was found in 32% and glenoid erosion was present in 37 shoulders: 24 mild, 5 moderate and 8 severe. Glenoid biconcavity did not show a statistically different survival rate (P<.8452) or Neer rating (P<.1185). Conclusions: The data from this study suggest that there is a high rate of unsatisfactory results and revision surgery with hemiarthroplasty for osteoarthritis. Careful consideration should be made of the relative benefits of this procedure compared to total shoulder arthroplasty for osteoarthritis. If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use). If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use). If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use).