Pyrocarbon humeral heads for hemishoulder arthroplasty grant satisfactory clinical scores with minimal glenoid erosion at 5-9 years of follow-up

Abstract

Hemi-shoulder arthroplasty (HSA) is a more conservative alternative to total shoulder arthroplasty (TSA) for young and active patients with minimal glenoid erosion or deformity. Pyrocarbon humeral heads were introduced as an alternative to metallic humeral heads which were associated with glenoid erosion in 28%-43%. The purpose of this study was to evaluate the progression of glenoid erosion and clinical scores of HSA using pyrocarbon humeral heads from short- (2-4 years) to mid-term (5-9 years). We retrieved records of 45 consecutive patients that underwent HSA with pyrocarbon humeral heads from 2013 to 2015. Patients were evaluated radiographically and clinically at a 'first' follow-up (2-4 years) and a 'second' follow-up (5-9 years). Preoperative glenoid morphology was assessed using computed tomography (CT) scans and glenoid erosion was assessed using plain radiographs according to Sperling et al 27. The Constant score (CS), American Shoulder and Elbow Surgeons (ASES) and Subjective Shoulder Value (SSV) score were assessed by an independent observer. From the initial cohort of 45 patients, 2 underwent revision surgery (4.4%) due to persistent pain (without signs of rotator cuff pathology or glenoid erosion), and 6 were lost to follow-up (13%), leaving 37 for outcome assessment (82%). At first follow-up of 2.2 ± 0.4 years all clinical scores improved substantially (CS from 29.3±13.5 to 76.7±14.4, ASES from 23.7±15.6 to 87.0±16.0, and SSV from 25.3±12.2 to 84.1±15.2) and at second follow-up of 6.2 ± 1.2 years good clinical scores were maintained (CS from 76.7±14.4 to 80.8±16.0, ASES from 87.0±16.0 to 92.3±15.0, and SSV from 84.1±15.2 to 82.8±18.3). At second follow-up, glenoid erosion was moderate in 9 (24%) and severe in 3 (8.1%). When comparing to immediate postoperative radiographs, 10 shoulders exhibited progression of glenoid erosion by 1 grade (n=9) or 2 grades (n=1). Pyrocarbon humeral heads for HSA grant satisfactory clinical scores with minimal glenoid erosion.