Midterm outcomes following humeral head replacement with rotator cuff reconstruction for cuff tear arthropathy in patients younger than 65 years of age

Abstract

BackgroundHumeral head replacement (HHR) using a small-diameter head with rotator cuff reconstruction is a useful therapeutic option for cuff tear arthropathy (CTA) with relatively low complication and revision rates, particularly in younger patients. This study evaluated the medium- to long-term clinical and radiographic outcomes of HHR for CTA in patients under 65 years old who were followed up for at least 5 years. MethodsThis retrospective case series included 16 shoulders of 15 patients under 65 years old who underwent HHR for CTA between 2007 and 2013 (12 shoulders in men, 4 in women). The mean age at surgery was 59.6 (range, 54-64) years. The mean follow-up duration was 8.5 (range, 6.2-11.0) years. No patient needed a revision surgery during the follow-up period. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score before and 2, 5, and at least 8 years postoperatively. All cases were followed for at least 5 years and 11 were followed for more than 8 years. Glenoid wear (GW), humeral bone resorption, and loosening of the humeral stem were evaluated on radiographs. Final clinical outcomes were evaluated according to GW and bone resorption. ResultsNo serious complications occurred during or after surgery, and the implant survival rate was 100%. Statistically significant improvements in all clinical parameters were found at 2 and 5 years postoperatively. At the final follow-up, there were significant improvements in active flexion (89.7° ± 42.4° vs. 146.8° ± 21.2° P = .01), JOA pain score (5.9 ± 2.0 vs. 22.7 ± 7.5, P = .005), and total JOA score (52.5 ± 9.6 vs. 81.9 ± 9.5, P < .001). GW at the final follow-up was grade 0 in 2 shoulders, grade 1 in 3, grade 2 in 4, and grade 3 in 7 (3A, 1; 3B, 3; and 3C, 3). Grade 4 bone resorption occurred in only 1 case at zone 1. No stem loosening was observed. There was no significant difference in the final clinical outcome according to GW or bone absorption. ConclusionThe results of HHR for CTA were stable and satisfactory with no serious complications or need for revision in patients under 65 years old. Moreover, there was no significant decline in clinical outcomes from the short to long term. Grade 3 GW occurred in 43.8% of cases but without any discernible effect on clinical outcomes.