Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger

doi:10.1016/j.jse.2004.03.013

Journal of Shoulder and Elbow Surgery

Volume 13, Issue 6, November–December 2004, Pages 604-613

https://doi.org/10.1016/j.jse.2004.03.013 Get rights and content

Abstract

Seventy-eight Neer hemiarthroplasties and thirty-six Neer total shoulder arthroplasties were performed in patients aged 50 years or younger between January 1, 1976, and December 31, 1985. Sixty-two hemiarthroplasties and twenty-nine total shoulder arthroplasties with complete preoperative evaluation, operative records, and a minimum 15-year follow-up (mean, 16.8 years) or follow-up until revision were included in the clinical analysis. Sixteen patients died, and seven were lost to follow-up. All 114 shoulders were included in the survival analysis. There was significant long-term pain relief (P < .01) and improvement in active abduction (P < .01) and external rotation (P < .01) with both procedures. There was not a significant difference between total shoulder arthroplasty and hemiarthroplasty with regard to pain relief, abduction, or external rotation. Radiographs were available for 53 hemiarthroplasties and 25 total shoulder arthroplasties with a minimum 10-year follow-up. Humeral periprosthetic lucency was present more frequently after total shoulder arthroplasty (60%) compared with hemiarthroplasty (34%) (P = .0079). Glenoid erosion was present in 38 of 53 hemiarthroplasties (72%). Glenoid periprosthetic lucency was present in 19 of 25 total shoulder arthroplasties (76%). The results were graded by use of a modified Neer result rating system. Among the hemiarthroplasties, there were 6 excellent (10%), 19 satisfactory (30%), and 37 unsatisfactory results (60%). Among total shoulder arthroplasties, there were 6 excellent (21%), 9 satisfactory (31%), and 14 unsatisfactory results (48%). The estimated survival rate for hemiarthroplasty was 82% (95% CI, 74%-92%) at 10 years and 75% (95% CI, 64%-86%) at 20 years. The estimated survival rate for total shoulder arthroplasty was 97% (95% CI, 91%-100%) at 10 years and 84% (95% CI, 68%-98%) at 20 years. The data from this study indicate that there is marked long-term pain relief and improvement in motion with shoulder arthroplasty. However, there is a moderate rate of hemiarthroplasty revision for painful glenoid arthritis. Unsatisfactory result ratings were most commonly a result of motion restriction from soft-tissue abnormalities. Great care must be exercised, and alternative methods of treatment considered, before either hemiarthroplasty or total shoulder arthroplasty is offered to patients aged 50 years or younger.

Section snippets

Materials and methods

Between January 1, 1976, and December 31, 1985, 78 Neer hemiarthroplasties and 36 Neer TSAs were performed in patients aged 50 years or younger. All 78 hemiarthroplasties and 36 TSAs were included in the Kaplan-Meier survival analysis, with a revision procedure defined as the endpoint. The patient characteristics of this cohort and method of data analysis with shorter follow-up have been reported previously.8 Sixteen hemiarthroplasties and seven TSAs included in the survival analysis were

Hemiarthroplasty

Four patients had postoperative complications not requiring a revision procedure. One had an immediate postoperative hematoma that resolved after aspiration. In another, subacromial bursitis developed 9 months after hemiarthroplasty, which resolved with a steroid injection. One patient sustained a brachial plexus neuropathy that resolved postoperatively. In one patient, an infection developed 2 months after hemiarthroplasty, which resolved after arthroscopic irrigation and intravenous

Discussion

In the past, there has been little information available to guide clinical decision making with regard to shoulder arthroplasty in young patients. In addition, there have been few long-term studies of shoulder arthroplasty in patients of all ages. A review of 41 series with 1858 TSAs revealed a mean follow-up of only 3.5 years.11 There were 21 reports with a minimum follow-up of 2 years; only 5 studies had a mean follow-up of 5 years or longer.11 To our knowledge, the present study has the

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Cited by (389)

Pyrocarbon humeral heads for hemishoulder arthroplasty grant satisfactory clinical scores with minimal glenoid erosion at 5-9 years of follow-up
2024, Journal of Shoulder and Elbow Surgery
Hemishoulder arthroplasty (HSA) is a more conservative alternative to total shoulder arthroplasty for young and active patients with minimal glenoid erosion or deformity. Pyrocarbon humeral heads were introduced as an alternative to metallic humeral heads, which were associated with glenoid erosion in 28%-43%. The purpose of this study was to evaluate the progression of glenoid erosion and clinical scores of HSA using pyrocarbon humeral heads from short- (2-4 years) to midterm (5-9 years).
We retrieved the records of 45 consecutive patients who underwent HSA with pyrocarbon humeral heads from 2013 to 2017. Patients were evaluated radiographically and clinically at a first follow-up (2-4 years) and a second follow-up (5-9 years). Preoperative glenoid morphology was assessed using computed tomography scans, and glenoid erosion was assessed using plain radiographs according to Sperling et al. The Constant score (CS), American Shoulder and Elbow Surgeons (ASES) score, and Subjective Shoulder Value (SSV) score were assessed by an independent observer.
From the initial cohort of 45 patients, 2 underwent revision surgery (4.4%) due to persistent pain (without signs of rotator cuff pathology or glenoid erosion) and 6 were lost to follow-up (13%), leaving 37 for outcome assessment (82%). At the first follow-up of 2.2 ± 0.4 years, all clinical scores improved substantially (CS from 29.3 ± 13.5 to 76.7 ± 14.4, ASES from 23.7 ± 15.6 to 87.0 ± 16.0, and SSV from 25.3 ± 12.2 to 84.1 ± 15.2), and at the second follow-up of 6.2 ± 1.2 years, good clinical scores were maintained (CS from 76.7 ± 14.4 to 80.8 ± 16.0, ASES from 87.0 ± 16.0 to 92.3 ± 15.0, and SSV from 84.1 ± 15.2 to 82.8 ± 18.3). At the second follow-up, glenoid erosion was moderate in 9 (24%) and severe in 3 (8.1%). When comparing with immediate postoperative radiographs, 10 shoulders exhibited progression of glenoid erosion by 1 grade (n = 9) or 2 grades (n = 1).
Pyrocarbon humeral heads for HSA grant satisfactory clinical scores with minimal glenoid erosion.
Clinical outcomes of revision to anatomic total shoulder arthroplasty
2024, Seminars in Arthroplasty JSES
Anatomic total shoulder arthroplasty (aTSA) remains the gold-standard for management of end-stage glenohumeral arthritis. However, in the setting of failed hemiarthroplasty or aTSA, the appropriate utilization of revision to an anatomic vs. reverse TSA remains unknown. This study aims to assess the outcomes of revision to aTSA.
All revision shoulder arthroplasty cases at a single institution by one of five fellowship-trained surgeons were reviewed. All aseptic revision cases where the revision construct was an aTSA were included. Attempts were made to contact each case for enrollment in the institution’s shoulder registry and ascertain any cases requiring revision surgery. Patient-reported outcome measures: American Shoulder and Elbow Surgeons score, single assessment numeric evaluation, visual analog scale for pain, patient satisfaction, and a validated scale of patient-reported shoulder range-of-motion were collected.
Twenty eight cases underwent revision aTSA between 2004 and 2019. The average age was 53.4 years (range: 23-66), 16 (57%) were male, and 14 (50%) were revised from a hemiarthroplasty while the remainder were revised from an aTSA. Seven (25%) cases required revision surgery at a mean 1.8 years. Three of these cases had been revised from hemiarthroplasty. Reasons for revision included: glenoid loosening (1), infection (1), rotator cuff failure (3), and persistent pain of nonspecific etiology (2). Ultimately, 6 (21%; 6/28) were revised to reverse TSA at a mean of 2 years (range: 1 month-5.7 years) postoperatively. Patients requiring further revision surgery were older (58.8 vs. 51.4 years; P = .06) than those not requiring further revision. Of the patients managed with lesser tuberosity osteotomy, the revision rate was 7.1% (1/14) compared to 42.9% (6/14) for the remainder of the cohort (P = .08). Of the 21 patients with retained aTSA, 15 (71%) provided clinical follow-up at an average of 4 years (range: 1-8). These patients had a mean American Shoulder and Elbow Surgeons score of 70.2 (range: 41-94), visual analog scale pain score of 2.8 (range: 0-6), single assessment numeric evaluation score of 52.1% (range: 14-92), and satisfaction of 73% (range: 1-100).
The outcomes of revision shoulder arthroplasty to an aTSA construct are varied. While in the appropriately indicated young patient high-quality results can be achieved, there is a high revision rate and highly variable patient-reported outcomes. Surgeons should be selective when recommending revision to an aTSA. Further study is needed to better predict successful outcomes in this patient population.
Assessing ChatGPT responses to frequently asked questions regarding total shoulder arthroplasty
2024, Seminars in Arthroplasty JSES
“Dr. Google” has long been a resource for health information-seeking individuals. With the well-established presence of artificial intelligence in the healthcare world, it is reasonable to imagine that ChatGPT, an artificial intelligence-powered online chatbot, could become the next outlet for seeking medical advice online. Similar to Mika et al, this study aims to analyze the ChatGPT’s ability to answer frequently asked questions (FAQs) regarding total shoulder arthroplasty (TSA).
Ten FAQs regarding TSA were presented to ChatGPT and initial responses were recorded and analyzed against evidence-based literature. Responses were rated as “excellent response requiring no clarification,” “satisfactory response requiring minimal clarification,” “satisfactory response requiring moderate clarification,” or “unsatisfactory response requiring substantial clarification.”
Only one response from ChatGPT was rated unsatisfactory and required substantial clarification. While no responses received an excellent rating, the average rating was considered to only require minimal or moderate clarification.
ChatGPT was able to provide largely accurate responses to FAQs regarding TSA while appropriately reiterating the importance of always consulting a medical professional. ChatGPT could prove to be another avenue for supplementary medical information regarding TSA.
Anatomic total shoulder arthroplasty with stemless humeral component, nonspherical head, and inlay glenoid: clinical outcomes at mean 4.4-year follow-up
2024, Seminars in Arthroplasty JSES
Limitations of traditional stemmed anatomic total shoulder arthroplasty (aTSA) with a spherical head and onlay glenoid include 1) inaccurate replication of native nonspherical humeral head kinematics, 2) substantial bone resection, and 3) susceptibility to glenoid loosening. Our purpose was to examine the outcomes of stemless aTSA with a nonspherical head and inlay glenoid.
Sixty patients (63 shoulders) with end-stage glenohumeral osteoarthritis were treated by a single surgeon. The study population was limited to 22 patients/25 shoulders (13 male, 12 female; mean age 65.6 years) with 2-year minimum follow-up (mean 51.8 months) subdivided into 2 groups by age. The young group included 5 patients/5 shoulders (3 male, 2 female; mean age 52.2 years; mean follow-up 62.4 months), while the elderly group included 17 patients/20 shoulders (10 male, 10 female; mean age 68.9 years; mean follow-up 49.2 months). At the final follow-up, patient satisfaction and complications were evaluated and the Constant-Murley, American Shoulder and Elbow Surgeons, and SF-36 scores were compared to preoperative values. First postoperative radiographs were compared to the final follow-up for signs of gross loosening, implant tilt, subsidence, and periprosthetic radiolucency.
No humeral shaft fractures, infections, glenoid/humeral component loosening, radiolucencies, shoulder dislocations, or neurovascular complications were encountered. No reoperations or revisions were performed. The entire study population (25 shoulders) showed significant increases in the Constant score (47.4-82.8, P < .001), American Shoulder and Elbow Surgeons score (36.9-88.1, P < .001), and all components of the SF-36 score (P < .014) except general health perceptions (P = .490), role imitations (emotional) (P = .232), and mental health (P = .746), with a 95% patient satisfaction rate. There were no significant differences between the young and elderly groups in any outcomes (P > .107).
Our results suggest that stemless aTSA performed with a nonspherical humeral head and inlay glenoid is a safe and effective treatment for glenohumeral osteoarthritis in both young and elderly patients. However, longer term studies with larger patient populations will be required for corroboration.
Comparison of anatomic total shoulder arthroplasty outcomes in younger and older patients with primary glenohumeral arthritis
2024, Seminars in Arthroplasty JSES
Elective shoulder arthroplasty is commonly performed in elderly patients with end-stage arthritis. However, a significant number of young patients also undergo this procedure. The surgical outcomes for young patients are not extensively studied compared to older patients. This study aimed to assess the short-term outcomes of anatomic total shoulder arthroplasty (aTSA) in patients aged 18-50 years with primary glenohumeral arthritis and compare them to patients aged 65-75 years.
A retrospective review was conducted on aTSA procedures performed for glenohumeral arthritis at a single hospital system between January 1^st, 2005, to September 15^th, 2023. Patients aged 18-50 years with a minimum 2-years of follow-up were compared to a cohort of patients aged 65-75 years. Data included range of motion and patient-reported outcome measures (Disabilities of the Arm, Shoulder, and Hand [DASH], American Shoulder and Elbow Surgeons, Simple Shoulder [SS], and Visual Analog Scale pain scores), which were compared between the two groups preoperatively and at final follow-up.
The younger group included 19 shoulders with a mean age of 44.2 ± 6.4 years at the time of surgery and a mean follow-up of 3.9 ± 1.9 years. The older group included 27 shoulders with a mean age of 70.3 ± 3.0 years at the time of surgery and a mean follow-up of 2.5 ± 0.8 years. The younger group failed to show improvements in all range of motion parameters at final follow-up, while the older group demonstrated improvement in range of motion for all measures. The older group had superior forward elevation and abduction at final follow-up. Both groups exhibited improvements in pain and shoulder function at final follow-up. The younger group did not show significant improvement in DASH scores at final follow-up. Preoperatively, the older group had significantly better DASH and SS scores compared to the younger group. The older group had significantly better DASH, American Shoulder and Elbow Surgeons, SS, and pain scores at final follow-up compared to the younger group.
Both groups experienced significant improvement in pain and subjective outcome measures after a 2-year follow-up. Despite this, the younger cohort had worse shoulder range of motion outcomes and lower function and higher pain scores than the older cohort. Nonetheless, aTSA remains a valuable treatment option for young patients in the short-term. However, it is crucial to consider that younger patients may experience dissatisfaction and receive less pain relief compared to older patients, and these factors should be considered when determining the suitability of this treatment approach.
Pyrocarbon hemiprostheses show little glenoid erosion and good clinical function at 5.5 years of follow-up
2024, Journal of Shoulder and Elbow Surgery
The success of traditional shoulder hemiarthroplasty (HA) with cobalt-chromium heads is limited by painful glenoid erosion with problematic bone loss. Hemiprostheses with pyrolytic carbon (PyC) heads have shown reduced glenoid erosion in experimental laboratory studies. Few in vivo data are available.
We performed a single-center consecutive cohort study of 31 of 34 patients (91%) who underwent PyC HA between September 2013 and June 2018. In 11 of these patients, concentric glenoid reaming was additionally performed. The mean follow-up period was 5.5 years (range, 3.5-7 years). Standardized radiographs were taken, and clinical function (Constant score) and pain (visual analog scale score) were recorded. Anteroposterior radiographs were analyzed according to an established method by 2 independent observers: A line parallel to the superior and inferior glenoid rim was translated to the most medial point of the glenoid surface. A further parallel line was placed on the spinoglenoid notch. The distance between these 2 lines was measured. Measurements were scaled using the known diameter of the implanted humeral head component. To assess eccentric erosion, anteroposterior and axial images were classified according to Favard and Walch, respectively.
Mean medial glenoid erosion measured 1.4 mm at an average of 5.5 years of follow-up. In the first year, 0.8 mm of erosion was observed, significantly more than the average erosion per year of 0.3 mm (P < .001). Mean erosion per year was 0.4 mm in patients with glenoid reaming vs. 0.2 mm in those without reaming (P = .09). An evolution of glenoid morphology was observed in 6 patients, of whom 4 had a progression of the erosion grade. The prosthesis survival rate was 100%. The Constant score improved from 45.0 preoperatively to 78.0 at 2-3 years postoperatively and 78.8 at latest follow-up (5.5 years postoperatively) (P < .001). The pain score on a visual analog scale decreased from 6.7 (range, 3-9) preoperatively to 2.2 (range, 0-8) at latest follow-up (P < .001). There was a weak correlation (r = 0.37) between erosion and pain improvement (P = .039) and no correlation between erosion and change in Constant score (r = 0.06).
PyC HA caused little glenoid erosion and a sustained improvement in clinical function in our cohort at mid-term follow-up. PyC demonstrates a biphasic development of glenoid erosion, with a reduced rate after the first year. PyC HA should therefore be considered as an alternative to cobalt-chromium HA and to anatomical total shoulder arthroplasty for patients with a high risk of glenoid component complications.

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Original articlesMinimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger

Abstract

Section snippets

Materials and methods

Hemiarthroplasty

Discussion

J Arthroplasty

Cemented total hip arthroplasty in patients younger than 50 years of age

Clin Orthop

Total shoulder arthroplasty with the Neer prosthesis

J Bone Joint Surg Am

Long-term results of Charnley low-friction arthroplasty in young patients

J Bone Joint Surg Br

Total hip replacement without cement for non-inflammatory osteoarthritis in patients who are less than forty-five years old

J Bone Joint Surg Am

Original articles
Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger