Published online Jun 18, 2021. doi: 10.5312/wjo.v12.i6.403
Peer-review started: January 27, 2021
First decision: March 8, 2021
Revised: March 15, 2021
Accepted: May 22, 2021
Article in press: May 22, 2021
Published online: June 18, 2021
Processing time: 135 Days and 4.7 Hours
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.
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.
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.
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.
HHR remains a reasonable option in patients with an intact rotator cuff for the treatment of OA and avascular necrosis.
Core Tip: Shoulder arthroplasty is the most effective treatment of glenohumeral osteoarthritis. The medium-term outcome and survival of a cementless humeral head resurfacing was retrospectively evaluated in 23 patients affected with osteoarthritis or avascular necrosis after a 7.4 year follow-up. 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. Humeral head resurfacing remains a reasonable option in patients with an intact rotator cuff for the treatment of osteoarthritis and avascular necrosis.