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J Shoulder Elbow Surg. 2014 Jan;23(1):e14-22. doi: 10.1016/j.jse.2013.05.001. Epub 2013 Jul 5.

Durability of partial humeral head resurfacing.

Author information

1
Harvard Shoulder Service, Brigham & Women's Hospital, Boston, MA, USA.
2
Harvard Shoulder Service, Brigham & Women's Hospital, Boston, MA, USA; Brigham & Women's Hospital, Boston, MA, USA.
3
Brigham & Women's Hospital, Boston, MA, USA.
4
Harvard Shoulder Service, Brigham & Women's Hospital, Boston, MA, USA. Electronic address: jwarner@partners.org.

Abstract

BACKGROUND:

Partial humeral head resurfacing arthroplasty uses a stemless device, which conserves bone and restores normal anatomy. We hypothesized that this does not offer a reasonable alternative to full resurfacing or total shoulder arthroplasty.

METHODS:

We performed a retrospective study of 39 shoulders with focal chondral defects of the humeral head treated with partial resurfacing arthroplasty. A minimum of 2 years' follow-up was reported, unless failure and operative intervention superseded this duration. The mean follow-up period was 51.3 months. The mean age was 45.6 years (range, 27-76 years). Preoperative and postoperative evaluation included history, physical examination, radiographs, and clinical scoring with the American Shoulder and Elbow Surgeons Shoulder Score Index and Subjective Shoulder Value.

RESULTS:

Of the 39 shoulders, 25 (64.1%) showed functional improvement and decreased pain. Significant mean improvements were observed in forward flexion (121° to 152°, P = .002), external rotation (37° to 58°, P = .0003), mean Subjective Shoulder Value (31% to 74%, P < .0001), and ASES score (29 to 70, P < .0001). However, at a mean of 26.6 months' follow-up, the failure group included 6 patients (15.3%) who underwent revision and another 4 (10.2%) who were recommended to undergo revision. Patients with no prior or concomitant procedures were rare (n = 5) but had the most reliable outcomes with partial resurfacing, with no failures in that group. Of the 24 patients with prior procedures, 5 had undergone revision, and the clinical outcome scores for the remaining patients were consistently lower than those seen in patients without prior procedures.

CONCLUSION:

Concomitant pathology and prior or concomitant surgical procedures potentially impair the outcome of the resurfacing procedure and could be a contraindication. Long-term success remains guarded with this treatment modality, especially in patients whose chondral injury is not an isolated finding.

KEYWORDS:

Case Series; Humeral head; Level IV; Treatment Study; chondral defect; glenohumeral arthritis; resurfacing arthroplasty

PMID:
23834995
DOI:
10.1016/j.jse.2013.05.001
[Indexed for MEDLINE]
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