Cementless humeral head resurfacing for degenerative glenohumeral osteoarthritis fails at a high rate

Maier, Michael W.; Hetto, Pit; Raiss, Patric; Klotz, Matthias; Bülhoff, Matthias; Spranz, David M.; Zeifang, Felix

doi:10.1016/j.jor.2018.02.013

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…According to the findings of the present study, the clinical and radiological results were good in a mean term follow-up of more than 7 years using the Aequalis HHR in the treatment of glenohumeral OA and humeral head AVN compared to similar data reported in the literature[ 9 , 11 , 14 , 16 - 19 ] (Figure 5 ).…”

Section: Discussionsupporting

confidence: 82%

“…The cementless implant may preserve the bone stock, and this aspect could be useful during a future revision[ 7 ]. Moreover, HHR may be considered a valid alternative in the post-traumatic arthropathy to restore shoulder anatomy[ 7 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…A direct correlation between overstuffing and glenoid wear has been demonstrated, leading to prosthesis failure[ 13 ]. Moreover, an operative change of the lateral glenohumeral offset as a predictive factor for implant failure has been reported[ 14 ]. Among other causes for prosthesis failure, rotator cuff tear, painful stiffness without glenoid erosion, or infections were reported[ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study

Chillemi¹,

Paglialunga

Giorgi

et al. 2021

WJO

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BACKGROUND 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. AIM 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. METHODS 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. RESULTS 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. CONCLUSION HHR remains a reasonable option in patients with an intact rotator cuff for the treatment of OA and avascular necrosis.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study

Chillemi¹,

Paglialunga

Giorgi

et al. 2021

WJO

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“…Resurfacing hemiarthroplasty (RHA) was developed to restore normal anatomy, and with a bone-preserving design and short operation time, it has often been preferred for the treatment of glenohumeral osteoarthritis [ 4 , 10 , 26 , 27 ]. Some studies have reported good functional outcome and a low rate of revision [ 14 – 16 , 22 , 23 , 28 , 31 ], while others report a poor functional outcome and a high risk of revision [ 7 , 8 , 10 , 11 , 17 , 24 ]. This has led to concerns that RHA may not adequately restore humeral anatomy [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Studies evaluating the restoration of glenohumeral joint anatomy following RHA have been conflicting. Some report that RHA restores humeral head anatomy [ 9 , 18 , 30 ] while others report increased lateral glenohumeral offset (LGHO) [ 14 , 17 – 20 , 28 ], displacement of the center of rotation [ 3 ], increased humeral head size [ 27 ], and a tendency to place the implant in varus [ 14 , 18 ]. Despite a lack of a clear definition, the term overstuffing has also been widely used in the literature as a possible cause of persistent pain or a poor functional outcome following RHA [ 1 – 3 , 6 , 18 , 19 , 21 , 25 – 27 , 29 , 30 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Low inter-observer agreement among experienced shoulder surgeons assessing overstuffing of glenohumeral resurfacing hemiarthroplasty based on plain radiographs

et al. 2018

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BackgroundIn a clinical setting, a visual evaluation of post-implant radiographs is often used to assess the restoration of glenohumeral joint anatomy after resurfacing hemiarthroplasty and is a part of the decision-making process, in combination with other parameters, when evaluating patients with inferior clinical results. However, the reliability of this method of visual evaluation has not been reported. The aim of this study was to investigate the inter- and intra-observer agreement among experienced shoulder surgeons assessing overstuffing, implant positioning, and size following resurfacing hemiarthroplasty using plain standardized radiographs.MethodsSix experienced shoulder surgeons independently classified implant inclination, size of the implant and if the joint seemed overstuffed, in 219 cases of post-implant radiographs. All cases were classified twice 3 weeks apart. Only radiographs with an anterior-posterior projection with a freely visible joint space were used. Non-weighted Cohen’s kappa values were calculated for each coder pair and the mean used as an estimate of the overall inter-observer agreement.ResultsThe overall inter-observer agreement for implant size (kappa, 0.48 and 0.41) and inclination angle was moderate in both rounds (kappa, 0.46 and 0.44), but only a fair agreement was found concerning the evaluation for stuffing of the joint (kappa, 0.24 and 0.28). Intra-observer agreement for implant size and stuffing ranged from fair to substantial while the agreement for inclination was moderate to substantial.ConclusionsOur results indicate that a visual evaluation of plain radiographs may be inadequate to evaluate overstuffing, implant positioning, and size following resurfacing hemiarthroplasty using plain standardized radiographs. Future studies may contribute to elucidate whether reliability increases if consensus on clear definitions and standardized methods of evaluation is made.

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Stemless Shoulder Arthroplasty for Glenohumeral Arthritis in a Young Patient

Shah

Grawe

2022

Glenohumeral Osteoarthritis in the Young Patient

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Cementless humeral head resurfacing for degenerative glenohumeral osteoarthritis fails at a high rate

Abstract: The study shows a high revision-rate (24%). Predictor for an implant failure was an operative changing of the LGHO.

Cited by 8 publications

References 27 publications

Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study

Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study

Low inter-observer agreement among experienced shoulder surgeons assessing overstuffing of glenohumeral resurfacing hemiarthroplasty based on plain radiographs

Stemless Shoulder Arthroplasty for Glenohumeral Arthritis in a Young Patient

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