Shoulder Hemiarthroplasty with Nonprosthetic Glenoid Arthroplasty

Matsen, Frederick A.; Carofino, Bradley C.; Green, Andrew; Hasan, Samer S.; Hsu, Jason E.; Lazarus, Mark D.; McElvany, Matthew D.; Moskal, Michael J.; Parsons, Moby; Saltzman, Matthew D.; Warme, Winston J.

doi:10.2106/jbjs.rvw.20.00243

Cited by 16 publications

(9 citation statements)

References 63 publications

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“…Getz et al reported a revision rate of 25% at a mean of 2.7 years 25 . We believe, consistent with Matsen et al, that patient selection and expectations are important factors for achieving a successful outcome after RnR 22 . Patients treated with RnR may benefit from avoiding long-term glenoid loosening and failure, which was reported to result in a glenoid revision rate of 29% at 20 years 8 .…”

Section: Discussionsupporting

confidence: 90%

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Comparison of Humeral-Head Replacement with Glenoid-Reaming Arthroplasty (Ream and Run) Versus Anatomic Total Shoulder Arthroplasty

Levins

Molla

Adkins

et al. 2023

Journal of Bone and Joint Surgery

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Background: Glenoid component failure is a major concern after anatomic total shoulder arthroplasty (aTSA). Ream and run (RnR) is an alternative procedure that may avoid glenoid-related complications. The purpose of this study was to compare outcomes of RnR versus aTSA in younger patients with advanced glenohumeral osteoarthritis.Methods: This was a retrospective matched-cohort study of 110 patients who underwent aTSA and 57 patients who underwent RnR; patients were <66 years of age and had a minimum of 2 years of follow-up. Propensity matching was performed using 21 preoperative variables. Pre-and postoperative patient-reported outcome measures (PROMs) and health-related quality-of-life (HRQoL) scores, satisfaction with outcome, and revision data were analyzed. Mixed-effects models examined the association of preoperative variables with outcomes.Results: Thirty-nine patient pairs were matched. All patients were male, with a mean age of 58.6 ± 7.3 years and a mean follow-up 4.4 ± 2.3 years. The aTSA cohort had better final Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) scores. However, in the mixed-effects model analysis, arthroplasty type was not associated with outcome. At 2 years postoperatively, a significantly greater percentage of aTSA patients achieved the substantial clinical benefit (SCB) for the ASES (100% versus 79.2%; p = 0.01) and the minimal clinically important difference (MCID) (89.7% versus 75%; p = 0.02) for the visual analog scale (VAS) for pain. At >5-year follow-up, there were no significant differences between the cohorts in the percentage who achieved the MCID, SCB, or patient acceptable symptom state (PASS) for the ASES, SST, and VAS for pain. Three patients underwent revision arthroplasty for pain after RnR, at a mean of 1.9 ± 1.7 years. Two patients underwent revision arthroplasty for glenoid loosening at 9.2 and 14 years after aTSA.Conclusions: RnR and aTSA had comparable outcomes in most analyses. The greater early revision rate after RnR should focus attention on optimizing patient selection and postoperative management. Revision for glenoid loosening is a concern among younger and active patients. Longer-term study is needed to better understand the relative benefits and disadvantages of these procedures.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Early outcomes of anatomic total shoulder arthroplasty (aTSA) are excellent with regard to patient-reported outcome measures (PROMs) and revision rates. However, glenoid failure requiring revision has been reported to occur at a rate of 17% at 10 years and 29% at 20 years postoperatively, with risk factors including younger age, higher activity level, and eccentric posterior glenoid wear 1-10 . Many surgeons recommend activity restrictions after aTSA because of concerns over glenoid failure 11 . The management of a failed glenoid component after aTSA is challenging, and revision to reverse shoulder arthroplasty (RSA) for glenoid loosenin...

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Section: Discussionsupporting

confidence: 90%

“…Proposed advantages include the preservation of glenoid bone stock and a lack of postoperative activity restrictions related to the glenoid compared with aTSA. Several reports, many by Matsen and colleagues, document excellent outcomes [18][19][20][21][22][23][24] . Other groups have reported more limited experiences.…”

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Comparison of Humeral-Head Replacement with Glenoid-Reaming Arthroplasty (Ream and Run) Versus Anatomic Total Shoulder Arthroplasty

Levins

Molla

Adkins

et al. 2023

Journal of Bone and Joint Surgery

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“…The so-called ream and run technique has previously been reported in which the glenoid is reamed without being resurfaced with a polyethylene component. Although not the best option for all patients, there have been good results reported 13,14 . This technique has been used in patients with dysplastic glenoid, glenoid morphology not amenable to resurfacing, and in cases of glenoid fracture preventing stable insertion of a glenoid component.…”

Section: Discussionmentioning

confidence: 99%

Stemless Hemiarthroplasty and Anterior Capsular Reconstruction in the Setting of a Residual Humeral Limb

Park

Jenkins

Stetler

et al. 2022

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Case:We present a 58-year-old left hand–dominant woman with right glenohumeral osteoarthritis and anterior instability in the setting of a congenital residual limb at the level of the mid-humerus. She had persistent pain and dysfunction despite trying conservative treatments and elected for a stemless or “canal-sparing” hemiarthroplasty with anterior capsular reconstruction. At the 2-year follow-up, there was significant improvement in her pain, motion, and function without signs of radiographic loosening.Conclusion:A stemless humeral implant is a versatile component that can be used in the face of humeral dysplasia, such as this patient with a congenital residual limb.

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“…The ream-and-run procedure combines HA with concentric spherical glenoid reaming to correct glenoid articular surface incongruity in order to recenter the humeral head and create durable glenoid articulation without implant or graft [46][47][48][49][50][51][52][53]. The procedure provides an alternative to TSA using a conventional all-polyethylene glenoid implant.…”

Section: Discussionmentioning

confidence: 99%

Prosthetic shoulder arthroplasty in patients 40 years or younger: outcomes stratified by diagnosis and surgery

Hasan

Schwindel²,

Fleckenstein

2022

Clin Shoulder Elbow

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Background: The outcomes of patients 50–55 years old or younger undergoing prosthetic shoulder arthroplasty (PSA) may not be generalizable to younger patients. We report outcomes following PSA in a consecutive series of patients 40 years or younger. Our hypothesis was that total shoulder arthroplasty (TSA) provides better outcome and durability than resurfacing hemiarthroplasty (RHA). Methods: Primary PSA in patients 40 years or younger were stratified by diagnosis and surgical procedure performed, RHA or TSA. Active range of motion and self-assessed outcome were evaluated preoperatively and at final follow-up. Results: Twenty-nine consecutive PSAs were identified in 26 patients, comprising 9 TSAs and 20 RHAs, with a minimum of 2-year follow-up. Twelve PSAs were performed for chondrolysis. Mean active forward elevation, abduction, external rotation, and internal rotation improved significantly (p<0.001 for all). Mean pain score improved from 6.3 to 2.1, Simple Shoulder Test from 4.0 to 9.0, and American Shoulder and Elbow Surgeons score from 38 to 75 (p<0.001 for all). Patients undergoing RHA and TSA had similar outcomes; but three RHAs required revision, two of these within 4 years of implantation. Four of five patients undergoing revision during the study period had an original diagnosis of chondrolysis.Conclusions: PSA in young patients provides substantial improvement in active range of motion and patient reported outcomes irrespective of diagnosis and glenoid management. However, patients undergoing RHA, especially for chondrolysis, frequently require subsequent revision surgery, so that RHA should be considered with caution in young patients and only after shared decision-making and counsel on the risk of early revision to TSA.

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Shoulder Hemiarthroplasty with Nonprosthetic Glenoid Arthroplasty

Cited by 16 publications

References 63 publications

Comparison of Humeral-Head Replacement with Glenoid-Reaming Arthroplasty (Ream and Run) Versus Anatomic Total Shoulder Arthroplasty

Comparison of Humeral-Head Replacement with Glenoid-Reaming Arthroplasty (Ream and Run) Versus Anatomic Total Shoulder Arthroplasty

Stemless Hemiarthroplasty and Anterior Capsular Reconstruction in the Setting of a Residual Humeral Limb

Prosthetic shoulder arthroplasty in patients 40 years or younger: outcomes stratified by diagnosis and surgery

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