Humeral head resurfacing is associated with less pain and clinically equivalent functional outcomes compared with stemmed hemiarthroplasty at mid-term follow-up

Abstract

Purpose Humeral head resurfacing (HHR) is a less invasive, anatomic alternative to the conventional stemmed hemiarthroplasty in patients in whom isolated humeral head replacement is preferred. It was hypothesized that, in a mid-term crosssectional subjective outcome analysis, HHR would have equivalent patient-reported and functional outcomes to stemmed hemiarthroplasty (HA). Methods A total of 213 HHR and 153 HA procedures were performed at a single academic institution from 2000 to 2014. Of these, 106 HHR and 47 HA patients corresponding with 120 HHR and 55 HA shoulders responded to a survey that collected patient demographics, surgical outcomes, patient satisfaction, and self-reported range of motion scores using both bespoke and validated metrics. Results Follow-up was longer in the HA group (9.4 ± 3.4 vs. 5.2 ± 1.8 years, p < 0.0001). Self-reported range of motion was equivalent between groups. Surgery was perceived as helpful following 76.7% of HHRs and 78.2% of HAs (p > 0.99). The ASES pain subscore was signiicantly worse in the HA group (25.2 ± 29.5 vs. 38.5 ± 12.7 after HHR, p < 0.0001), which translated into worse ASES total scores (45.1 ± 14.8 HA vs. 52.2 ± 23.7 HHR, p < 0.05). These indings were equivocal in responses received 2-8 years vs. ≥ 8 years after surgery. Conclusions Indications should be equivocal; humeral head resurfacing is a viable alternative to hemiarthroplasty, with equivalent patient satisfaction and reduced pain in the mid-term post-operative period. Level of evidence III.

Resurfacing hemiarthroplasty versus stemmed hemiarthroplasty for glenohumeral osteoarthritis: a meta-analysis

“…Included studies [39,40,[45][46][47][48]] that compared outcomes between RHA and SHA were included in this meta-analysis. The search strategy through the PRISMA flow diagram is detailed in Fig.…”

“…Four studies [45][46][47][48] reported postoperative range of motion, but only two studies [45,46] with homologous data could be combined to assess the degree of forward flexion and external rotation. The degree of internal rotation could not be calculated due to insufficient data.…”

“…Four studies [45][46][47][48] employed three different scoring scales to evaluate postoperative pain of patients while only two studies [45,46] that reported VAS scores were included. The pooled results demonstrated that patients in the SHA group achieved better results than those in the RHA group (SMD 0.61; 95% CI 0.23 to 0.98; p = 0.001, I 2 = 41.4%) ( Fig.…”

“…The data about overall postoperative complications were extracted from four studies [45][46][47][48], which included 201 shoulders in the RHA group and 131 shoulders in the SHA group. The meta analysis found that there was no significant difference in complication rates between the two groups (OR 1.42; 95% CI 0.83 to 2.40, p = 0.198) without heterogeneity (p = 0.756, I 2 = 0%) ( Fig.…”

“…The revision rates were reported or calculated in all studies [39,40,[45][46][47][48], involving a total of 1356 RHA and 1212 SHA procedures. The pooled data showed that the revision rate after RHA was higher than that after SHA (OR 1.50; 95% CI 1.08-2.09, p = 0.016), with a low heterogeneity (p = 0.231, I 2 = 28.6%) (Fig.…”