Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study

Abstract

BACKGROUND Glenohumeral osteoarthritis (OA) is a common cause of pain and disability affecting nearly a third of the world’s population over 60 years of age. As in other joints, shoulder arthroplasty appears to be the most effective treatment. The implant design has evolved during time transitioning to shorter humeral stem lengths or even stemless components. AIM To evaluate the medium-term outcome and survival of a cementless humeral head resurfacing (HHR) in a group of patients affected with OA or avascular necrosis. METHODS This is a retrospective study of prospectively collected data using HHR in 23 patients (15 female and 8 male) after a 7.4 year follow-up. The collected data included clinical and radiographical evaluation. The Constant score, the visual analogue scale, and a clinical evaluation of range of motion were registered pre- and postoperatively. Fifteen patients affected with OA (2 cases of mild, 6 moderate, and 7 severe) and 10 with avascular necrosis (stage III according to Cruess classification) were enrolled. X-rays were evaluated to detect loosening signs, degenerative changes, and superior humeral head migration. Magnetic resonance preoperatively was also performed to assess the rotator cuff status. Tendon integrity was mandatory to implant the HHR. RESULTS In total, 19 patients (21 shoulders) completed the follow-up. Data on 4 shoulders, in 4 patients, were lost because of prosthesis failure. The global revision rate was 16%. A statistically significant improvement in the mean Constant score, visual analogue scale, and range of motion have been reported. No signs of loosening were registered, while in 12 cases a glenoid erosion was found. The osteophytes appeared 7 times on the humeral side and 12 on the glenoid. Superior humeral migration was recorded in only 1 case. CONCLUSION HHR remains a reasonable option in patients with an intact rotator cuff for the treatment of OA and avascular necrosis.

Long-term survival of resurfacing humeral hemiarthroplasty

“…Similar results have been shown in a recent long-term study where the overall complication rate was 15.4%, and the two main complications were pain due to glenoid erosion and stiffness [21]. The two reasons for the pain were related to RHHI positioning and overstuffing [17,20,22]. Moreover, pain after an RHHI has been a problem, especially with the Copeland implant, as overstuffing seems to cause pain due to the implant design [22].…”

“…In contrast to those results, Levy et al reported no revision after 4.4 years of follow-up, and Al-Hadithy et al reported a revision rate of 2% after 4.2 years [3,18]. In the mid-term follow-up studies, reported revision rates varied from 16 to 17% [19,20]. In the long-term follow-up studies, Geervliet et al reported a revision rate of 23% at 9 years, and Gadea et al reported a 10-year prosthesis survival of 88.1% [15,21].…”

Humeral Head Resurfacing for Isolated Primary Humeral Osteoarthritis With a Large Chondral Defect

“…Furthermore, resurfacing requires shorter operative time, is less invasive, and is less technically demanding compared with anatomic TSA or reverse TSA. 10,11 Lastly, resurfacing leaves the native glenoid intact, which reduces risk of glenoid loosening or failure in young active individuals, which can allow for greater shoulder functional demands. Stemless implant designs may provide an additional advantage of improved outcomes as compared with their stemmed counterparts.…”