COPELAND SURFACE REPLACEMENT ARTHROPLASTY OF THE SHOULDER FOR SEVERE BONE LOSS – EXTENDING THE FRONTIERS

Abstract

Copeland Surface replacement arthroplasty provides a good outcome in cases of arthritis. However, the limitation of use of this prosthesis is severe bone loss of the humeral head.

We describe the use of Copeland Surface Replacement Shoulder Arthroplasty in cases of severe humeral head destruction extending more than 50% of the humeral head. The bone deficiency was reconstructed with the autograft from the reaming and reshaping of the humeral head and a synthetic bone graft substitute (Tricalcium phosphate granules (Biosorb)) mixed with the patient’s blood.

We report preliminary results in 8 cases. 3 males and 4 females (One patient bilateral). The average age was 48 years ( 22–76 years). 5 cases had Posttraumatic avascular necrosis of humeral head, two patients had locked posterior fracture dislocation with loss of more than 50% of the humeral head and one patient with severe juvenile rheumatoid arthritis.

In this series the remaining bone of humeral head was less than 50% ranging between 30–50% (average 38%).

The patients were followed clinically and radiographically. The average follow–up was 10.6 months (range: 5 to 15 months).

All patients had substantial improvement in there shoulder function and pain. All the patients were very satisfied. Average pre-op constant score was 9.3 points (range: 9–14). At the latest follow-up the average constant score was 59 (range: 36–74). Age and sex adjusted constant score was 68.6 (range: 37– 87).

Radiographically we observed good incorporation of the Bone graft substitute with no signs of loosening or any lucencies under the prosthesis.

These are early and encouraging results in this group of young patients with severe destruction of the humeral head. It seems like it may provide a good bone preserving solution in these cases and extend the frontiers for the surface replacement of the shoulder.