K Soudy1, C Szymanski2, C Lalanne2, C Bourgault2, A Thiounn2, A Cotten3, C Maynou2. 1. Service d'orthopédie A, Hôpital Roger Salengro, CHRU Lille, rue Emile Laine, 59000 Lille, France. Electronic address: ksoudy@gmail.com. 2. Service d'orthopédie A, Hôpital Roger Salengro, CHRU Lille, rue Emile Laine, 59000 Lille, France. 3. Service d'imagerie ostéo-articulaire, Hôpital Roger Salengro, CHRU Lille, rue Emile Laine, 59000 Lille, France.
Abstract
BACKGROUND: The objective of this study was to assess clinical and computed-tomography (CT) outcomes at least 2 years after humeral head resurfacing to treat concentric gleno-humeral osteoarthritis. HYPOTHESIS: Humeral head resurfacing provides similar outcomes to those achieved with stemmed humeral head implants. MATERIALS AND METHODS: This single-centre retrospective study included 40 Copeland™ and 65 Aequalis™ humeral resurfacing heads implanted between 2004 and 2012. Mean patient age at diagnosis was 64 years. The diagnoses were osteoarthritis with an intact (68%) or torn (21%) rotator cuff, avascular necrosis (5%), osteoarthritis complicating chronic instability (3%), post-traumatic osteoarthritis (2%), and chronic inflammatory joint disease (1%). Validated clinical scores, radiographs, and CT before surgery and at last follow-up were compared. RESULTS: During the mean follow-up of 56 months, complications occurred in 24 implants. Revision surgery with reverse shoulder replacement was required in 18 cases, after a mean of 43.6 months, to treat glenoid wear or a rotator cuff tear. At last follow-up, for the implants that did not require revision surgery, the mean Constant score was 64/100. The implants had a mean varus of 5° and mean retroversion of -13.3°. The mean increase in glenoid cavity depth was 2.4mm. Mean increases in medial and lateral humeral offset were 1.9mm and 2.7mm, respectively. Pre-operative factors significantly associated with failure were rotator cuff tear (P=0.017) and glenoid erosion (P=0.001). DISCUSSION: We found a high failure rate related to glenoid wear or progressive rotator-cuff impairment, although CT showed no evidence of implant malposition or overstuffing. Previous studies of stemmed humeral head implants showed better outcomes. Given the low medium-term prosthesis survival rate, we now reserve humeral head resurfacing for concentric osteoarthritis without glenoid erosions or rotator cuff damage. LEVEL OF EVIDENCE: IV, retrospective study.
BACKGROUND: The objective of this study was to assess clinical and computed-tomography (CT) outcomes at least 2 years after humeral head resurfacing to treat concentric gleno-humeral osteoarthritis. HYPOTHESIS: Humeral head resurfacing provides similar outcomes to those achieved with stemmed humeral head implants. MATERIALS AND METHODS: This single-centre retrospective study included 40 Copeland™ and 65 Aequalis™ humeral resurfacing heads implanted between 2004 and 2012. Mean patient age at diagnosis was 64 years. The diagnoses were osteoarthritis with an intact (68%) or torn (21%) rotator cuff, avascular necrosis (5%), osteoarthritis complicating chronic instability (3%), post-traumatic osteoarthritis (2%), and chronic inflammatory joint disease (1%). Validated clinical scores, radiographs, and CT before surgery and at last follow-up were compared. RESULTS: During the mean follow-up of 56 months, complications occurred in 24 implants. Revision surgery with reverse shoulder replacement was required in 18 cases, after a mean of 43.6 months, to treat glenoid wear or a rotator cuff tear. At last follow-up, for the implants that did not require revision surgery, the mean Constant score was 64/100. The implants had a mean varus of 5° and mean retroversion of -13.3°. The mean increase in glenoid cavity depth was 2.4mm. Mean increases in medial and lateral humeral offset were 1.9mm and 2.7mm, respectively. Pre-operative factors significantly associated with failure were rotator cuff tear (P=0.017) and glenoid erosion (P=0.001). DISCUSSION: We found a high failure rate related to glenoid wear or progressive rotator-cuff impairment, although CT showed no evidence of implant malposition or overstuffing. Previous studies of stemmed humeral head implants showed better outcomes. Given the low medium-term prosthesis survival rate, we now reserve humeral head resurfacing for concentric osteoarthritis without glenoid erosions or rotator cuff damage. LEVEL OF EVIDENCE: IV, retrospective study.
Authors: Andrea Beck; Hannah Lee; Mitchell Fourman; Juan Giugale; Jason Zlotnicki; Mark Rodosky; Albert Lin Journal: J Shoulder Elb Arthroplast Date: 2019-02-13
Authors: Nicolai Sandau; Stig Brorson; Bo S Olsen; Anne Kathrine Sørensen; Steen L Jensen; Kim Schantz; Janne Ovesen; Jeppe V Rasmussen Journal: J Orthop Surg Res Date: 2018-11-27 Impact factor: 2.359