Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2021; 12(6): 403-411
Published online Jun 18, 2021. doi: 10.5312/wjo.v12.i6.403
Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study
Claudio Chillemi, Carlo Paglialunga, Greta De Giorgi, Riccardo Proietti, Stefano Carli, Marco Damo
Claudio Chillemi, Department of Orthopaedics and Traumatology, Istituto Chirurgico Ortopedico Traumatologico, Latina 04100, Lazio, Italy
Carlo Paglialunga, Greta De Giorgi, Riccardo Proietti, Stefano Carli, Marco Damo, Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
Author contributions: All authors helped to carry out the research; Chillemi C contributed to the manuscript writing, performing procedures, drafting conception, and design and data analysis; Paglialunga C contributed to writing the manuscript, drafting conception, and design; De Giorgi G, Carli S, and Damo M contributed to writing the manuscript; Proietti R contributed to writing the manuscript and data analysis.
Institutional review board statement: The IRB approval was obtained October 30, 2019.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Claudio Chillemi, MD, Chief Doctor, Department of Orthopaedics and Traumatology, Istituto Chirurgico Ortopedico Traumatologico, Via Franco Faggiana 1668, Latina 04100, Lazio, Italy. c_chillemi@libero.it
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: March 8, 2021
Revised: March 15, 2021
Accepted: May 22, 2021
Article in press: May 22, 2021
Published online: June 18, 2021
Abstract
BACKGROUND

Glenohumeral osteoarthritis (OA) is a common cause of pain and disability affecting nearly a third of the world’s population over 60 years of age. As in other joints, shoulder arthroplasty appears to be the most effective treatment. The implant design has evolved during time transitioning to shorter humeral stem lengths or even stemless components.

AIM

To evaluate the medium-term outcome and survival of a cementless humeral head resurfacing (HHR) in a group of patients affected with OA or avascular necrosis.

METHODS

This is a retrospective study of prospectively collected data using HHR in 23 patients (15 female and 8 male) after a 7.4 year follow-up. The collected data included clinical and radiographical evaluation. The Constant score, the visual analogue scale, and a clinical evaluation of range of motion were registered pre- and postoperatively. Fifteen patients affected with OA (2 cases of mild, 6 moderate, and 7 severe) and 10 with avascular necrosis (stage III according to Cruess classification) were enrolled. X-rays were evaluated to detect loosening signs, degenerative changes, and superior humeral head migration. Magnetic resonance preoperatively was also performed to assess the rotator cuff status. Tendon integrity was mandatory to implant the HHR.

RESULTS

In total, 19 patients (21 shoulders) completed the follow-up. Data on 4 shoulders, in 4 patients, were lost because of prosthesis failure. The global revision rate was 16%. A statistically significant improvement in the mean Constant score, visual analogue scale, and range of motion have been reported. No signs of loosening were registered, while in 12 cases a glenoid erosion was found. The osteophytes appeared 7 times on the humeral side and 12 on the glenoid. Superior humeral migration was recorded in only 1 case.

CONCLUSION

HHR remains a reasonable option in patients with an intact rotator cuff for the treatment of OA and avascular necrosis.

Keywords: Shoulder, Arthroplasty, Humeral head, Resurfacing, Glenoid erosion, Prosthesis failure

Core Tip: Shoulder arthroplasty is the most effective treatment of glenohumeral osteoarthritis. The medium-term outcome and survival of a cementless humeral head resurfacing was retrospectively evaluated in 23 patients affected with osteoarthritis or avascular necrosis after a 7.4 year follow-up. The global revision rate was 16%. A statistically significant improvement in the mean Constant score, visual analogue scale, and range of motion have been reported. No signs of loosening were registered, while in 12 cases a glenoid erosion was found. Humeral head resurfacing remains a reasonable option in patients with an intact rotator cuff for the treatment of osteoarthritis and avascular necrosis.