Humeral head resurfacing for fixed anterior glenohumeral dislocation

Abstract

The purpose of this prospective study was to describe cementless humeral surface replacement arthroplasty (CHSRA) as a bone preserving treatment option for patients with fixed anterior glenohumeral dislocation. Ten patients with post-traumatic fixed anterior glenohumeral dislocation underwent CHSRA with a mean follow-up of 24 months. All patients were evaluated clinically using the Constant score and with radiographs in two planes. There were two reoperations: one patient developed glenoid erosion and was revised and in another case redislocation occurred. Clinical or radiographical signs of implant loosening were not found. The humeral head centred in the glenoid in nine out of ten cases radiographically. The Constant score increased from 20 points preoperatively to 61 points postoperatively (p<0.007). CHSRA is a viable treatment option for elderly patients with fixed anterior glenohumeral dislocation and bone defects of the humeral head. Good clinical results and a moderate complication rate were found in the short term.Résumé Le sujet de cette étude prospective était de montrer que le resurfaçage sans ciment au niveau de l'épaule est un option permettant la préservation du capital osseux pour des patients avec une luxation antérieure chronique de l'épaule. Dix patients avec une luxation gléno humérale antérieure fixée ont subi un resurfaçage sans ciment avec un suivi moyen de 24 mois. Tous les patients ont été évalués cliniquement à l'aide du score de Constant et des radiographies dans deux plans. Deux réinterventions ont été nécessaires. Un patient a développé une érosion glénoïdienne nécessitant un changement de prothèse et un patient a récidivé sa luxation. Il n'y avait pas de signe clinique ou radiographique de descellement des implants. La tête humérale était centrée dans la glène dans 9 cas sur 10. Le score de constant s'est accru de 20 points en préopératoire à 61 points en post opératoire (p<0.007). Le resurfaçage huméral sans ciment est donc une solution fiable pour les patients âgés avec une luxation antérieure chronique et une encoche au niveau de la tête humérale. De bons résultats clinique et un taux de complications modéré ont été retrouvés à court terme.

Complications in shoulder arthroplasty: an analysis of 485 cases

“…In the study of Bailie et al a complication rate of 16.7% was reported using resurfacing arthroplasty [2]. The rates in other studies seem to be comparable and vary between 3% and 20% without resurfacing the glenoid [17][18][19]24]. In contrast to the above-mentioned studies, we found a relatively high number of postoperative glenoid erosions (5.2%) and total number of complications (13%).…”

“…Cementless humeral head resurfacing is a bonepreserving treatment option for different diseases of the shoulder joint and later conversion to a conventional hemiarthroplasty or TSA is possible [17,18,24,25]. Short surgery time as well as minimal bone and blood loss are the main advantages [22].…”

Total shoulder arthroplasty in dislocation arthropathy

“…However, anterior defects resulting from chronic dislocations-especially in elderly patients-have also been described [31]. We believe that an improvement in external rotation is of critical importance in order to avoid a postoperative posterior subluxation with eccentric abrasion.…”

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

“…The technique requires patients to have at least 60% normal bone stock, hence is contraindicated in those with osteoporotic bone [88] . The largest case series performed by Raiss et al [89] only involved 10 patients. They performed uncemented partial resurfacing in locked anterior dislocation patients with significant humeral bone loss and found an increase Constant score of 41 points post operatively with two reoperations for dislocation and glenoid erosion.…”