Total Shoulder Arthroplasty Group Research Articles

Hemiarthroplasty Versus Total Shoulder Arthroplasty for Shoulder Osteoarthritis

Background: Return to activity is a commonly used indication for shoulder hemiarthroplasty (HA) compared with total shoulder arthroplasty (TSA). Despite clinical studies demonstrating better functional outcomes after TSA, the literature has failed to show a difference in return to sports. Purpose: To compare rates of return to sports in a matched cohort of TSA and HA patients with a preoperative diagnosis of glenohumeral osteoarthritis (OA). Study Design: Cohort study; Level of evidence, 3. Methods: A prospectively collected registry was queried retrospectively for consecutive patients who underwent HA. Inclusion criteria were preoperative diagnosis of OA and more than 2 years of follow-up. After meeting the inclusion criteria, all HA patients were statistically matched to a TSA patient. All patients had end-stage OA with significant glenohumeral joint space narrowing. Results: At final follow-up, 40 HA patients and 40 TSA patients were available. The average (±SD) age at surgery was 65.7 ± 10.5 years and 66.2 ± 9.6 years for the HA and TSA groups, respectively (P = .06). Average follow-up was 62.0 months and 61.1 months for the HA and TSA groups, respectively (P = .52). Average American Shoulder and Elbow Surgeons scores improved from 36.3 to 70.2 for HA patients and from 34.0 to 78.5 for TSA patients (P < .001 for both); final scores were not significantly different between groups (P = .21). Average visual analog scale pain scores improved from 6.3 to 2.2 for HA patients and from 6.1 to 0.6 for TSA patients (P < .001 for both). HA patients had significantly worse final visual analog scale scores compared with the TSA group (P = .002). Significantly more TSA patients were satisfied with their surgery compared with HA patients (100% vs 70%) (P = .01). Of both groups, 65.5% of HA patients (19 of 29) returned to at least 1 sport postoperatively compared with 97.3% of TSA patients (36 of 37) (P < .001). Average timing for return to full sports was 5.5 ± 4.2 months and 5.4 ± 3.1 months for the HA and TSA groups, respectively (P = .92). Significantly more TSA patients returned to higher upper extremity use sports (P = .01). Conclusion: In patients with OA, rate of return to sports was significantly better after TSA compared with HA. HA patients had significantly more pain, worse surgical satisfaction, and decreased ability to return to high upper extremity use sports. For patients with OA who wish to return to sporting activities, these results help manage expectations.

Shoulder arthroplasty for post-traumatic osteonecrosis of the humeral head

Osteonecrosis (ON) of the humeral head is a known complication of proximal humeral trauma. Prosthetic replacement may be the last option to treat the associated pain. Depending on the condition of the glenoid, hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) can be considered. To date, the peer reviewed literature offers limited direction on the better treatment for this population. Between 1973 and 2010, 93 arthroplasties were performed for post-traumatic ON of the humeral head after conservative treatments failed. Of these, 37 HAs and 46 TSAs were monitored for a minimum of 2 years (mean, 8.9 years) or until reoperation. The HA and TSA groups showed improvements in pain (P < .001), elevation (P < .01), and external rotation (P < .01). The TSA group had less pain at follow-up than the HA group (2.1 vs 3.0, P = .001). TSA led to better satisfaction (70% vs 56%) and more excellent/satisfactory Neer ratings (57% vs 41%) compared with HA. Nine HA patients and 5 TSA patients underwent reoperation. The most common causes for reoperation were painful glenoid arthrosis (n = 8) in HA and rotator cuff failure (n = 4) in TSA. The estimated 15-year survivorship was 79.5% for HA and 83% for TSA. In patients with post-traumatic ON of the humeral head, shoulder arthroplasty provides improvements in range of motion. However, TSA provides superior pain relief, with better patient-reported satisfaction. TSA should be strongly considered in patients with post-traumatic ON of the humeral head with damage to the glenoid cartilage.

Shoulder arthroplasty for atraumatic osteonecrosis of the humeral head

Osteonecrosis (ON) of the humeral head represents <5% of the shoulder arthroplasty population. Depending on the stage of disease, surgeons must decide between hemiarthroplasty (HA) and total shoulder arthroplasty (TSA). To date, the peer-reviewed literature offers minimal insight into the best form of treatment of this population of patients. Between August 1973 and November 2010, 141 shoulder arthroplasties were performed for operatively confirmed ON of the humeral head; 67 HAs and 71 TSAs were observed for at least 2 years (mean, 9.3 years) or until reoperation. Indications for surgery included imaging-confirmed ON in a patient who had failed to respond to conservative treatment modalities. Shoulder arthroplasty provided significant improvements in pain scores (P < .001), elevation (P < .01), and external rotation (P < .01) for both the HA and TSA populations. Both groups showed similar patient-reported satisfaction (>75%) and excellent/satisfactory Neer ratings (>65%). Eleven percent of HAs had moderate to severe glenoid erosion at follow-up, and 25% of glenoid components were radiographically at risk. Eight HAs and 11 TSAs underwent reoperation. The most common cause for reoperation was painful glenoid arthrosis in the HA group (7) and aseptic loosening (4) in the TSA group. The estimated 20-year survivorship of HA and TSA was 87% and 79%, respectively. In patients with atraumatic ON of the humeral head, both HA and TSA can be expected to provide lasting pain relief and improved range of motion, with HA having longer follow-up. HA should be strongly considered in patients with atraumatic ON of the humeral head and preserved glenoid cartilage.

Kinematic analysis of reaching movements of the upper limb after total or reverse shoulder arthroplasty

Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation.

Outcome and value of reverse shoulder arthroplasty for treatment of glenohumeral osteoarthritis: a matched cohort

Total shoulder arthroplasty (TSA) is commonly used to treat glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. Recently, reverse shoulder arthroplasty (RSA) has been used for GHOA patients who are elderly or have eccentric glenoid wear. We evaluated patients with GHOA scheduled to have TSA but who were changed to RSA because of intraoperative difficulties with the glenoid component or instability and compared them with a cohort that underwent TSA to determine if the groups had similar outcomes. We identified 24 consecutive GHOA patients who underwent RSA and matched them to 96 patients who underwent TSA. Glenoid wear and rotator cuff musculature were assessed with preoperative computed tomography scans. Direct hospital costs of the procedure were collected. Postoperative American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and range of motion were similar between the 2 groups. Five TSA patients had radiographic glenoid loosening, whereas no RSA patients did. Neither group required a revision. One RSA patient required surgery for treatment of a periprosthetic fracture. RSA was $7274 more costly than TSA, related mainly to implant cost. Patients with GHOA who were converted intraoperatively to RSA because of improper seating of the glenoid trial or persistent posterior subluxation had outcomes comparable to those of a similar group of patients in whom TSA was performed. At midterm follow-up, TSA is associated with lower cost than RSA. The higher rate of radiographic loosening in the TSA group warrants longer follow-up to assess revision costs. In cases in which a TSA cannot be performed with confidence, RSA is a reasonable alternative.

Validity of the QuickDASH in patients with shoulder-related disorders undergoing surgery.

Validity study. To determine the validity of the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) in comparison to the full DASH in patients undergoing total shoulder arthroplasty (TSA) and rotator cuff repair (RCR). The QuickDASH is a shorter version of the DASH that may reduce respondent burden while retaining similar measurement properties. One hundred thirty-two patients undergoing TSA or RCR were assessed at baseline and at 3 and 6 months postoperatively. The patients completed the DASH, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form self-report section, and the Western Ontario Rotator Cuff index, and were tested to determine their shoulder range of motion and isometric strength. The differences between scores on the DASH and QuickDASH across the scale range were evaluated using the Bland-Altman technique. Item difficulty, correlations with other patient-reported outcome measures, and physical impairments were used to assess validity. Known group validity was assessed by examining differentiation of work status. Responsiveness was assessed through standardized response means. QuickDASH scores were slightly higher than DASH scores, with a mean difference of 1 to 1.3 points for the TSA group and 1 to 3 points for the RCR group tested preoperatively, and at 3 months and 6 months postoperatively, although limits of agreement were wide (ranging from -10 to 13 across all estimates). The QuickDASH items were distributed across the full DASH, when ranked by item difficulty, for both patient groups. The correlation between the QuickDASH and DASH was almost perfect (r>0.92). Correlations between the DASH/QuickDASH and other patient-reported outcome measures ranged from moderate to very large (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form self-report section, r=0.47-0.85; Western Ontario Rotator Cuff index, r=0.83-0.91), whereas correlations to impairments were small to moderate. Correlation estimates varied by less than 0.07, depending on whether the DASH or QuickDASH was used, suggesting equivalent construct validity. Both the DASH and QuickDASH discriminated between working and nonworking patients, with similar group differences and statistical significance (P<.01). The QuickDASH and DASH showed similar responsiveness between presurgery and 6-month follow-up (standardized response mean, 1.1 following TSA and 0.8 following RCR). When substituting the QuickDASH for the full DASH, similar score estimates, discrimination of clinically relevant subgroups, and responsiveness can be expected across patients following TSA and RCR.

National trends and perioperative outcomes in primary and revision total shoulder arthroplasty: Trends in total shoulder arthroplasty.

Total shoulder arthroplasty (TSA) is a highly successful procedure for management of glenohumeral arthritis, fractures and rotator cuff tears. The purpose of this study was to evaluate patient demographics, perioperative outcomes and assess recent national trends in both primary and revision TSA. The National Hospital Discharge Survey database was searched for patients admitted to US hospitals for primary and revision TSA from 2001 to 2010. A total of 1,297 patients who underwent primary TSA and 184 patients who underwent revision TSA were identified. The rates of primary TSA (r = 0.88) and revision TSA (r = 0.85) both demonstrated a strong positive correlation with time. The mean patient age of the primary group was significantly higher than the revision group. Gender was not significantly different between the groups. There was no significant difference in the racial make-up between the revision and primary groups. African Americans accounted for 3.3% of primaries versus 4.3% of revisions (p = 0.615). Revision TSA patients had a significantly longer average LOS (3.06days vs 2.46days, p < 0.01), more medical comorbidities (6.0 vs 5.1 comorbidities, p < 0.01) and a higher rate of developing a myocardial infarction (2.2% versus 0%, p < 0.01) than the primary TSA group. This study demonstrates that the rate of TSA is rapidly increasing in the US, with over a four-fold increase in revisions and five-fold increase in primaries over the tenyears studied.

Pattern of recovery following total shoulder arthroplasty and humeral head replacement.

BackgroundUnderstanding the pattern of recovery and expected rate of change after shoulder arthroplasty is helpful to clinicians and patients for setting realistic expectations and goals. The purpose of this study was to describe the pattern of recovery over a 2-year period for patients receiving either a Total Shoulder Arthroplasty (TSA) or Humeral Head Replacement (HHR).MethodsThis was a secondary analysis of prospectively collected data of patients who had undergone TSA or HHR and were followed for up to 2 years. Patients were seen prior to surgery and at 6 months, one year and two years after surgery and completed the American Shoulder and Elbow Surgeon’s (ASES) questionnaire, Relative Constant Murley score (RCMS) and underwent range of motion and strength assessment.ResultsData of 134 patients who had surgery from April 2001 to July 2011 were used for analysis. One hundred and eight patients underwent TSA (81%) and 26 (19%) had HHR. Both surgeries were associated with a statistically significant improvement in physical symptoms, ASES, RCMS, range of motion and strength (p <0.0001). The greatest change for all outcomes occurred within the first 6-months of surgery. Improvement in ASES, RCMS continued up to 12-months and then plateaued. Improvement in physical symptoms leveled off at 6-months in the HHR group but continued up to 12-months in the TSR group. Strength showed improvement in both groups up to 24-months post-surgery.ConclusionBoth TSA and HHR groups showed a statistically significant improvement in perceived disability, range of motion and strength over two years with the greatest improvement made by 6 months. The recovery profiles for the surgeries showed different patterns.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-306) contains supplementary material, which is available to authorized users.

Analysis of perioperative complications in patients after total shoulder arthroplasty and reverse total shoulder arthroplasty

Data directly comparing the perioperative complication rates between total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are limited. The Nationwide Inpatient Sample database, which comprises data from a statistically representative sample of hospitals across the United States, was analyzed for the years 2010 and 2011. The International Classification of Diseases, Ninth Revision procedure codes differentiated the patients who received TSA (81.80) and RTSA (81.88). Demographic data, comorbidities, perioperative complications, and hospitalization data were compared. This retrospective analysis included 19,497 patients, with 14,031 patients in the TSA group and 5466 patients in the RTSA group. Patients who underwent RTSA were older (P<.001), were more likely to be female (P<.001), and had increased rates of fracture (P<.001). The RTSA group had significantly higher perioperative rates of mortality (P=.004), pneumonia (P<.001), deep venous thrombosis (P<.001), myocardial infarction (P=.005), urinary tract infection (P<.001), and blood transfusions (P<.001). In addition, the RTSA patients had longer hospital stays (P<.001) and higher hospital charges (P<.001). The rates of comorbidities were also higher in the patients who underwent RTSA. After adjustment for these differences in comorbidities and surgical indications with our multivariate analysis, RTSA was still independently associated with increased hospital charges (differenceof$11,530; P<.001), longer hospitalization (differenceof0.24day; P<.001), more blood transfusions (relative risk,1.43; P<.001) and higher rates of pneumonia (relative risk,1.61; P=.04) and deep venous thrombosis (relative risk, 2.24; P=.01). We found that RTSA patients, compared with TSA patients, had significantly longer length of stay, higher hospital charges that are not completely attributable to increased implant costs alone, and increased rates of perioperative complications.

Perioperative complications after hemiarthroplasty and total shoulder arthroplasty are equivalent

Total shoulder arthroplasty (TSA) results in superior clinical outcomes to hemiarthroplasty (HA); however, TSA is a more technical and invasive procedure. This study retrospectively compares perioperative complications after HA and TSA using the National Surgical Quality Improvement Program (NSQIP) database. The NSQIP user file was queried for HA and TSA cases from the years 2005 through 2010. Major complications were defined as life-threatening or debilitating. All complications occurred within 30 days of the initial procedure. We performed multivariate analysis to compare complication rates between the two procedures, controlling for patient comorbidities. The database returned 1,718 patients (HA in 30.4% [n = 523] and TSA in 69.6% [n = 1,195]). The major complication rates in the HA group (5.2%, n = 29) and TSA group (5.1%, n = 61) were similar (P = .706). Rates of blood transfusions for postoperative bleeding in patients undergoing HA (2.3%, n = 12) and TSA (2.9%, n = 35) were indistinguishable (P = .458). Venous thromboembolism was a rare complication, occurring in 0.4% of patients in each group (2 HA patients and 5 TSA patients, P > .999). On multivariate analysis, the operative procedure was not associated with major complications (P = .349); however, emergency case, pulmonary comorbidity, anemia with a hematocrit level lower than 36%, and wound class of III or IV increased the risk of a major complication (P < .05 for all). Multivariate analysis of patients undergoing TSA or HA in the NSQIP database suggests that patient factors-not the procedure being performed-are significant predictors of major complications. Controlling for patient comorbidities, we found no increased risk of perioperative major complications in patients undergoing TSA compared with HA.

Total shoulder arthroplasty versus hemiarthroplasty for glenohumeral arthritis: A systematic review of the literature at long-term follow-up

Introduction:The optimal surgical treatment of end-stage primary glenohumeral osteoarthritis remains controversial. The objective of this article is to systematically review the current available literature to formulate evidence-based guidelines for treatment of this pathology with an arthroplasty.Materials and Methods:A systematic literature search was performed to identify all articles from 1990 onward that presented data concerning treatment of glenohumeral arthritis with total shoulder arthroplasty (TSA) or head arthroplasty (HA) with a minimal follow-up of 7 years. The most relevant electronic databases were searched.Results:After applying the inclusion and exclusion criteria, we identified 18 studies (of the initial 832 hits). The search included a total of 1,958 patients (HA: 316 and TSA: 1,642) with 2,111 shoulders (HA: 328 + TSA: 1,783). The revision rate for any reason in the HA group (13%) was higher than in the TSA group (7%) (P < 0.001). There was a trend of a higher complication rate (of any kind) in the TSA group (12%) when compared with the HA group (8%) (P = 0.065). The weighted mean improvement in anteflexion, exorotation and abduction were respectively 33°, 15° and 31° in the HA group and were respectively 56°, 21° and 48° in the TSA group. Mean decrease in pain scores was 4.2 in the HA and 5.5 in the TSA group.Conclusion:Finally, we conclude that TSA results in less need for revision surgery, but has a trend to result in more complications. The conclusions of this review should be interpreted with caution as only Level IV studies could be included.Level of Evidence:IV.

Total Shoulder Arthroplasty or Hemiarthroplasty: A Comparison of Complication Rates in the English National Health Service

Background There is debate regarding the benefit of glenoid resurfacing in shoulder arthroplasty. The present study aimed to compare the complication rates of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA). This is the first study to compare complication rates on a national scale. Methods Data were extracted from the Hospital Episode Statistics database for patients who underwent planned TSA or HA between 2005 and 2008 in the English National Health Service. Medical and surgical complications, as well as 18-month revision rates, were analysed for the whole cohort (9804 patients). A subset of 939 with longer follow-up was examined for 5-year revision rates. Results The 18-month revision rate was significantly higher in the TSA group (3.03% versus 1.76%; odds ratio = 1.75; 95% confidence interval = 1.33 to 2.28) but, at 5 years, there was no difference (3.85% versus 3.67%; odds ratio = 0.95; confidence interval = 0.46 to 1.91). The overall in-hospital 90-day mortality rate was 0.43%. There were no significant differences in 30-day readmission, wound complication and reoperation rates. The incidence of medical problems was low. Conclusions Despite concerns regarding osteolysis around the glenoid component after TSA, the present study reports no significant differences in complication rates between the groups at 5 years. However, the controversy surrounding glenoid resurfacing is likely to continue.

Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads

BackgroundFollowing shoulder arthroplasty, any well-planned rehabilitation program should include muscle strengthening. However, it is not always clear how different external loads influence shoulder kinematics in patients with shoulder prostheses. The objective of this study was to describe shoulder kinematics and determine the contribution of the scapulothoracic joint to total shoulder motion of patients with total and reverse shoulder arthroplasties and of healthy individuals during rehabilitation exercises (anteflexion and elevation in the scapular plane) using different loading conditions (without external load, 1kg and elastic resistance). MethodsShoulder motions were measured using an electromagnetic tracking device. A force transducer was used to record force signals during loaded conditions using elastic resistance. Statistical comparisons were made using a three-way repeated-measures analysis of variance with a Bonferroni post hoc testing. FindingsThe scapula contributed more to movement of the arm in subjects with prostheses compared to healthy subjects. The same applies for loaded conditions (1kg and elastic resistance) relative to unloaded tasks. For scapular internal rotation, upward rotation and posterior tilt no significant differences among groups were found during both exercises. Glenohumeral elevation angles during anteflexion were significantly higher in the total shoulder arthroplasty group compared to the reverse shoulder arthroplasty group. InterpretationDifferences in contribution of the scapula to total shoulder motion between patients with different types of arthroplasties were not significant. However, compared to healthy subjects, they were. Furthermore, scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load.

Nonprosthetic glenoid arthroplasty with humeral hemiarthroplasty and total shoulder arthroplasty yield similar self-assessed outcomes in the management of comparable patients with glenohumeral arthritis

The risk of glenoid component failure has led us to explore nonprosthetic glenoid arthroplasty coupled with humeral hemiarthroplasty, the "ream and run" (R&R) procedure, for the management of glenohumeral arthritis in active patients. We hypothesized that patients having a R&R procedure would have outcomes comparable with those of similar patients having a total shoulder arthroplasty (TSA). A case-matched control study compared 35 consecutive patients (32 men, 3 women) with an average age of 56 years, after R&R with matched controls having TSA. The respective Simple Shoulder Test (SST) scores for the R&R and TSA groups were 4.5 and 4.0 before surgery, 7.8 and 9.6 at 12 months, 8.3 and 10.2 at 18 months, 8.9 and 9.4 at 24 months, 9.4 and 9.6 at 30 months, and 9.5 and 10.0 at 36 months. The "ream and run" procedure can offer similar functional recovery to patients with total shoulder arthroplasty, although the time to recovery may be longer.

A Comparison of Pain, Strength, Range of Motion, and Functional Outcomes After Hemiarthroplasty and Total Shoulder Arthroplasty in Patients with Osteoarthritis of the Shoulder

A systematic review of the literature was performed to estimate the impact of hemiarthroplasty compared with total shoulder arthroplasty on function and range of motion in patients suffering from osteoarthritis of the shoulder. We conducted an electronic search for relevant studies published in any language from 1966 to 2004, a manual search of the proceedings from five major orthopaedic meetings from 1995 to 2003, and a review of the reference lists from potentially relevant studies. Four randomized clinical trials, with similar eligibility criteria and surgical techniques, that compared hemiarthroplasty and total shoulder arthroplasty for the treatment of primary osteoarthritis of the shoulder were found to be eligible. Authors from three of the four studies provided original patient data. Analysis of covariance focused on the two-year outcome and included a comparison of the aggregate University of California at Los Angeles shoulder score, four University of California at Los Angeles domain scores, and range of motion. A total of 112 patients (fifty managed with hemiarthroplasty and sixty-two managed with total shoulder arthroplasty), who had a mean age of sixty-eight years, were included in this analysis. A significant moderate effect was detected in the function domain of the University of California at Los Angeles shoulder score (p < 0.001) in favor of total shoulder arthroplasty (mean [and standard deviation], 8.1 +/- 0.3) compared with hemiarthroplasty (mean, 6.6 +/- 0.3). A significant difference in the pain score was found in favor of the total shoulder arthroplasty group (p < 0.0001). However, the large degree of heterogeneity (p = 0.006, I(2) = 80.2%) among the studies decreased our confidence that total shoulder arthroplasty provides a true, consistent benefit with regard to pain. There was a significant difference in the overall change in forward elevation of 13 degrees (95% confidence interval, 0.5 degrees to 26 degrees ) in favor of the total shoulder arthroplasty group (p = 0.008). At a minimum of two years of follow-up, total shoulder arthroplasty provided better functional outcome than hemiarthroplasty for patients with osteoarthritis of the shoulder. Since continuous degeneration of the glenoid after hemiarthroplasty or glenoid loosening after total shoulder arthroplasty may affect the eventual outcome, longer-term (five to ten-year) results are necessary to determine whether these findings remain consistent over time.

Shoulder arthroplasty for arthritis after instability surgery.

We are not aware of any large published studies regarding the intermediate to long-term results of shoulder arthroplasty performed for the treatment of osteoarthritis after instability surgery. Therefore, we reviewed the results of this procedure, the risk factors for an unsatisfactory outcome, and the rates of failure in our patients. Between January 1, 1978, and December 31, 1997, thirty-three patients (thirty-three shoulders) with glenohumeral arthritis after instability surgery were treated with a shoulder arthroplasty at our institution. Two patients were excluded from the study: one died less than two years postoperatively, and one had not been managed by the senior surgeon. The remaining thirty-one patients, including twenty-one patients who had had a total shoulder arthroplasty and ten who had had a hemiarthroplasty, were followed for a minimum of two years (mean, seven years) or until the time of revision surgery. The mean age at the time of the shoulder arthroplasty was forty-six years. Shoulder arthroplasty was associated with significant pain relief (p < 0.001) as well as significant improvement in external rotation (from 4 degrees to 43 degrees; p < 0.001) and active abduction (from 94 degrees to 141 degrees; p < 0.001). There was not a significant difference between the hemiarthroplasty group and the total shoulder arthroplasty group with regard to postoperative external rotation, active abduction, or pain. According to a modification of the rating system of Neer et al., there were four excellent, two satisfactory, and four unsatisfactory results in the hemiarthroplasty group and three excellent, five satisfactory, and thirteen unsatisfactory results in the total shoulder arthroplasty group. Three patients in the hemiarthroplasty group and eight patients in the total shoulder arthroplasty group underwent revision surgery. The estimated survival of the components (and 95% confidence interval) was 97% (91% to 100%) at two years, 86% (74% to 99%) at five years, and 61% (42% to 86%) at ten years. The data from the present study suggest that shoulder arthroplasty for the treatment of osteoarthritis of the glenohumeral joint following instability surgery in this relatively young group of patients provides pain relief and improved motion but is associated with high rates of revision surgery and unsatisfactory results due to component failure, instability, and pain due to glenoid arthritis.