SH2: HEMI-ARTHROPLASTY VERSUS TOTAL SHOULDER REPLACEMENT FOR OSTEOARTHRITIS – A 10 YEAR REVIEW

Abstract

We prospectively compared hemiarthroplasty (HA) and total shoulder replacement (TSR) in cuff intact osteoarthritis. The 2 years postoperative review, which has been presented previously, showed an advantage of TSR over HA. This study reviewed the longer term outcome in the same patients at a minimum of 10 years to assess the longer term durability of the glenoid components. Patients with Osteoarthritis and an intact rotator cuff were intraoperatively randomisation to HA or TSR using the Global^™ Shoulder Arthroplasty system after glenoid exposure. Post-operative mobilisation for the two groups was identical, and up until two years, patients were assessed using the UCLA and Constant Score, as well as analog pain scales and functional questionnaire. At the 10 year review patients were assessed using a similar range of subjective evaluations by telephone, or reviewed in the clinic as was possible

Thirty-three shoulders in thirty-two patients were entered into the trial (14 HA and 19 TSR). At six months and one year, function scores and motion were similar, but the TSR group had less pain than the HA patients (p < 0.05) and this became more apparent at two years postoperatively (p< 0.02). Apart from those who died, no patients were lost to follow-up. At the two year mark postoperatively one patient in the HA group had undergone revision to TSR due to severe pain secondary to glenoid erosion, and three further HA were subsequently revised (2 at 3 years, and one at 4 years). Two shoulders in the TSR group have been revised (at 5 years and 7 years). At 10 years from the initial arthroplasty, 5 of the 14 HA and 6 of the 19 TSR had died. 10 of the 14 HA (71%) and 17 of the 19 TSR (89%) remained in situ at the time of death or at the 10 year review. Overall outcomes in each group were similar with respect to pain, function, daily activities. Based on this longer term review, our recommendation remains that TSR has advantages over HA with respect to pain and function at two years, and there has not been a reversal of the outcomes on prolonged follow-up. Revision from HA to TSR is made difficult due to glenoid erosion. Overall 89% of TSR remain insitu at death or 10 year, whereas 71% of HA were intact at the same times. The contention that HA will avoid later arthroplasty complications and, in particular, an unacceptable rate of late glenoid failure is not supported by this longer term review.