Evaluation of hemiarthroplasty as a treatment modality for glenohumeral arthritis

ABSTRACT

Prosthetic shouder arthroplasty [PSA] is no longer an experimental procedure, it is in fact a successful operation. In this study 28 patients underwent a Neer shoulder hemiarthroplasty [16 were evaluated on a prospective basis and 12 on a retrospective basis]. The underlying pathology was RA in 23 patients and OA in 5 patients. There were 21 females and 7 males, ranging in age from 40 to 83 years [mean 65]. The follow up period ranged between 12 and 64 months [mean 33]. All the prostheses used were of the Neer Mark II design, where a 23mm head was used in all patients with OA and a 15mm head was used in all patients with RA. Our procedure was done with the patients in beach-chair position, through a delto-pectoral approach and using a freehand technique for the humeral osteotomy. All our patients received an extensive postoperative rehabilitation program that continued for at least 6 months. We used the Constant scoring system for evaluating our procedures and Wilcoxon signed rank test for statistical analysis of our results. The resultes of 23 shoulder of RA had an improvement in all cases [100%] in their total Constant score-power excluded-with a mean improvement of 34.61 points which was statistically highly significant and also for the 5 shoulders of OA [100%] with a mean improvement of 53 points. Radiographically, none of the shoulders in our series developed subluxation or dislocation apart from transitory inferior subluxation, no heterotopic bone formation, no change in implant position, and incomplete lucencies less than 1mm in 6 of our 28 prostheses which did not progress. We concluded that improvement in pain and sleep is a universal achievement of this procedure regardless of the type of prosthesis and underlying pathology, for these reasons patient satisfaction is extremely high, however better results were achieved when the underlying pathology is OA as the rotator cuff is intact