Endoprosthetic surface replacement of the humeral head

Abstract

The concept of an endoprosthetic surface replacement of the humeral head differs from that of stemmed endoprostheses. It is the replacement of the destroyed joint surface with reconstruction of the normal anatomy and minimal bone resection. The aim of this prospective study was to evaluate the short-term results of a newly developed cup arthroplasty (Durom-Cup) for the humeral head. In a prospective study, 39 patients with 46 Durom-Cups were evaluated preoperatively and every 3 months postoperatively. The average follow-up was 15 +/- 9 months. The group included 28 shoulders with rheumatoid arthritis, 15 joints with osteoarthritis, and 3 humeral head necroses. The Constant-score and SAS-function score were used. The Constant-score increased from 20.25 +/- 9.06 points preoperatively to 46.62 +/- 14.05 at 3 months, to 48.11 +/- 14.49 at 6 months, and to 55.25 +/- 11.6 at 9 months postoperatively. The Constant-score stayed at this level during further follow-up and was 55.81 +/- 16.31 at 12 months postoperatively. The best results were seen in the group of humeral head necroses with a Constant-score of 71.0 +/- 12.2 compared to 54.66 +/- 13.89 in the group of osteoarthritis and 56.78 +/- 13.33 in patients with rheumatoid arthritis at 12 months postoperatively. The results with the Durom-Cup are encouraging so that cup arthroplasty seems to be a good alternative to stemmed prostheses. The main advantages of the humeral head resurfacing are the bone-preserving fixation and the relatively simple surgical technique.

Use of Compressive Osseointegration Endoprostheses for Massive Bone Loss From Tumor and Failed Arthroplasty: A Viable Option in the Upper Extremity

“…Numerous studies have reported the outcomes after implantation of stemmed endoprostheses in the proximal humerus [3, 8, 11, 14, 20, 22, 24-26, 28, 30, 32], with longterm implant survivorship ranging from 87% to 97% [8,19]. Surgical outcomes have improved with modern endoprosthetics [3,8,11], and rates of aseptic loosening are less common than in the lower extremity, ranging from 0% to 7% in series mostly consisting of primary resection and reconstruction [3,8,9,13,19,24]. Aseptic loosening did not occur in either of our patients with proximal humeral endoprostheses, but did prompt revision of the standard, cemented ulnar component in two of our patients with the distal humeral CPS.…”

Der Oberflächenersatz des Humeruskopfes bei avaskulären Nekrosen und posttraumatischen Zuständen

“…Beim Oberflächenersatz wird nur wenig Knochensubstanz der zerstörten Gelenkfläche entfernt, um eine mög-lichst genaue Rekonstruktion der Anatomie wieder zu erreichen [3].…”

Mid-and Long-term Survival and Patient-reported Outcomes of Humeral Surface Replacement in 135 Shoulders

“…Of the different endoprostheses available, cementless or cemented surface replacement of the humeral head, rst described by Zippel [1] in 1975, has becoming less important; however, the operation time is shorter than for total shoulder arthroplasty or stemmed hemiarthroplasty [2], and the result is facile restoration of the anatomy and minimal bone resection, with low risk of periprosthetic fracture. Therefore, resurfacing allows preservation of bone stock should the need for revision arise in the future [3]. The main concern is that the revision rate is higher than that for total shoulder arthroplasty due to glenoid loss [4,5].…”