Long-term results of shoulder resurfacing hemiarthroplasty: Poor functional outcomes in rotator cuff deficient patients

Abstract

Background: Shoulder resurfacing hemiarthroplasty is a bone-conserving procedure used in the treatment of multiple painful shoulder conditions. Previous studies have reported mixed results with some indicating that rotator cuff arthropathy leads to inferior clinical outcomes when compared to other preoperative diagnoses. We compared the medium- to long-term subjective and functional outcomes of resurfacing hemiarthroplasty performed for rotator cuff arthropathy versus other indications.Methods: Patients who underwent shoulder resurfacing hemiarthroplasty, with minimum two-year follow-up, were included for review. The primary outcome measure was the final postoperative American Shoulder and Elbow Surgeons score, while secondary measures included final postoperative active forward elevation, revision arthroplasty, as well as the change in pre- and postoperative outcome scores and forward elevation.Results: Eighty-four shoulders in 77 patients were reviewed, including 39 shoulders with preoperative rotator cuff arthropathy. Mean follow-up time was 76.82 months (range 24 to 147 months). Improvements in subjective outcome scores and visual analog pain scores were observed with all preoperative diagnoses following surgery. There was no significant difference in final postoperative subjective scores when comparing patients with rotator cuff arthropathy and those with an intact rotator cuff (66.0 ± 22.8 vs. 74.2 ± 20.3, p = 0.09). Final postoperative active forward elevation was significantly worse in the rotator cuff arthropathy group compared to other diagnoses (119.1˚± 41.8˚ vs 136.9˚ ± 34.6˚, p = 0.040). Patients with rotator cuff arthropathy lost an average of 26.9˚ of forward elevation while those with an intact rotator cuff gained an average of 8.7˚ postoperatively (p = 0.001). Six shoulders from the rotator cuff arthropathy group were revised to reverse total shoulder arthroplasty compared to two from all other groups (15.4% vs 4.4%, p = 0.183).Conclusion: Shoulder resurfacing hemiarthroplasty is effective in relieving pain and improving subjective outcome scores across all diagnoses but does not reliably restore or maintain function in rotator cuff deficient patients. In fact, patients with rotator cuff arthropathy lost a significant amount of range of motion after resurfacing hemiarthroplasty. While patients predictably improve in terms of pain scores and subjective outcome scores, caution should be exercised in performing this procedure in patients with rotator cuff arthropathy, even those with preserved preoperative overhead active range of motion, due to potential loss of active range of motion after surgery.Level of evidence: Level III; Retrospective Comparative Study