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

Abstract

Background: Though total shoulder arthroplasty (TSA) has been an acknowledged treatment option for glenohumeral osteoarthritis, resurfacing hemiarthroplasty (RHA) and stemmed hemiarthroplasty (SHA) may be preferred in some circumstances by surgeons, especially for treating young or active patients. However, decision-making between the RHA and SHA is controversial. Therefore, we conducted a meta-analysis to systematically compare two surgical procedures in terms of postoperative functional outcomes, range of motion (ROM), pain relief, complication rates, risk of revision. Methods: The PubMed, Embase, Web of Science and Cochrane Library were searched from inception to January 1, 2020, for all articles that compared the clinical effectiveness and safety of RHA with SHA. All eligible studies were selected based on certain screening criteria. Two investigators independently conducted the quality assessment and extracted the data. Fixed-effect and random-effect models were used for pooled results according to the degree of heterogeneity. All statistical analyses were performed by employing Stata software 14.0. Results: A total of six comparative studies involving 2568 shoulders (1356 RHA and 1212 SHA) were included in the final analysis. Patients were followed up for at least 1 year in each study. Pooled results showed that RHA was associated with a better visual analog scale (SMD 0.61, p = 0.001) but higher revision rates (OR 1.50, p = 0.016) when compared to SHA. There were no significant differences in functional outcomes, such as Constant-Murley score (SMD 0.06, P = 0.878), American Shoulder and Elbow Surgeons score (SMD 0.05, P = 0.880), Western Ontario Osteoarthritis of the Shoulder index (SMD 0.43, p = 0.258) and quick-Disabilities of the Arm, Shoulder and Hand score (SMD 0.06, p = 0.669). In addition, no differences were observed in forward flexion (SMD 0.16, p = 0.622), external rotation (SMD-0.17, P = 0.741) and overall complication rates (OR 1.42, p = 0.198).

Anatomical shoulder replacements in young patients: A systematic review and meta-analysis

“…A recent meta-analysis of case series and cohort studies demonstrated similar shoulder scores and a higher revision rate in the resurfacing group. 13 The duration of follow-up was mixed, and the loss to follow-up was unclear. In the National Joint Registry of England Wales and Northern Ireland, the stemless hemiarthroplasty may have the greatest revision rate compared to resurfacing or stemmed replacements at 5 years across all ages.…”

“…These may have a lower risk of revision compared to stemless and resurfacing implants, however current reports are inconclusive. 12 , 13 …”

“…These may have a lower risk of revision compared to stemless and resurfacing implants, however current reports are inconclusive. 12,13 Risk of bias was assessed using the MINORS instrument. 14 This includes an eight-item assessment for noncomparative studies.…”

The Surgical Treatment of Osteoarthritis

“…Shoulder hemiarthroplasty (HA) involves only the replacement of the humeral articular surface and is performed when glenoid resurfacing is contraindicated due to poor glenoid bone stock or in other selected cases [ 72 , 73 ]. Resurfacing hemiarthroplasty (RHA) has alternatively been proposed in an attempt to restore joint congruency while conserving proximal humeral bone stock and native anatomy of glenohumeral articulation [ 74 ]. Cuff-tear arthropathy of the shoulder has proved itself as a complex and difficult-to-treat form of shoulder degeneration associated with a massive chronic tear or other form of rotator cuff insufficiency that manifests as proximal migration of the humerus and erosion of the superior part of glenoid.…”