Pyrocarbon hemiarthroplasty of the shoulder: indications and pitfalls

Abstract

AimsThe outcomes with metal head hemiarthroplasties (HA) are contrasted, especially in young, active patients. An innovative Pyrocarbon interface was introduced in 2014 in order to decrease potential glenoid wear. The aim of this study is to evaluate survival and short-term results of HA with a pyrocarbon head. MethodsWe conducted a retrospective single-centre study: 30 consecutive patients underwent HA with pyrocarbon humeral head and were assessed with a minimum follow-up of 2 years. The mean age at surgery was 54 ± 13 years; 38% of patients (n = 13) had undergone surgery at least once on the affected shoulder. Depending on the aetiology, 4 groups were analyzed: group 1 (osteonecrosis, n = 12), group 2 (primary gleno humeral osteoarthritis, n = 10), group 3 (fracture sequelae, n = 4) and group 4 (revision, n = 4). ResultsA significant improvement in clinical results was documented at mean follow-up of 38 months: mean Constant score (preop 35 ± 15 vs. postop 67 ± 19 points; <0.0001) and mean SSV (Subjective Shoulder Value; preop 35 ± 20 vs. postop 79 ± 16; <0.0001). Four patients (13%) required revision surgery with an average follow-up of 35 ± 12 months: two patients for infection (one in group 1 and the other in group 3), one patient for humeral false path (group 3) and one patient for rotator cuff tear (group 1). No revision was performed in groups 2 and 4. Glenoid wear did not increase significantly, regardless of the indication. In the subgroup analysis, the best gain was found in group 2: Constant score (+33 points; P< .001) and SSV (+50%; P< .001). The best results were obtained in group 4: Constant score 75 points and SSV score 87%. ConclusionHemiPYC provided satisfactory clinical outcomes without glenoid wear at short-term follow-up. Disappointing results were recorded in the case of severe fracture sequelae. Mid and long-term studies should be carried out to confirm these results. Level of evidenceLevel IV, retrospective case series.