Abstract
Aims: The innovative surgical procedure of humeral resurfacing emiarthroplasty is currently used for the treatment of younger patients, in need of a bone-preserving implant, affected by primary gleno-humeral osteoarthritis and rheumatoid arthritis, secondary degenerative joint disease, post-traumatic arthritis or mal-unions of the humeral head, loss of articular cartilage, joint incongruity and stiffness, avascular osteonecrosis of the humeral head, combined loss of the gleno-humeral joint surface and rotator cuff loss of function and pain unresponsive to nonoperative measures. Published reports have indicated a large variation in the benefits of this procedure. The aim of this study is to analyse the clinical results obtained by the authors in a preliminary report of a two-years experience in the surgical actuation of this procedure, that represents one of the most innovative options in the field of the shoulder arthroplasty.
Materials and Methods: The authors report the outcomes of their experience in humeral head surface replacement emiarthroplasty. In the last two years 25 selected patients have been treated according to the surgical implantation of the “bone sparing” Global Cap conservative anatomic prosthesis (DePuy). The mean age of the patients was 52 years (range, 34 to 76 years). They have been followed for a mean of 8 months, (range, 4 to 16 months).
Preoperative diagnoses were: osteoarthritis, rheumatoid arthritis, psoriasic arthritis, osteonecrosis and post traumatic arthritis. 8 patients underwent contextual cuff tear repair.
Results: Constant score for the whole group improved from a mean preoperative score of 22 to 60 at the last follow-up. Periprosthetic osteolisys was seen in 3 cases. One case of stiffness required narcosis mobilization at 5 months after surgery. Our results are comparable to those obtained with others modern R.R.H. and are similar to Copeland’s own series.
Conclusions: The preliminary results of our study show how some pre-operative factors appear to influence the functional improvement and the personal satisfaction rate of the patients after humeral resurfacing emiarthroplasty. The most important are represented by: the presence of erosions in the glenoid cartilage, possible previous shoulder surgery and associated cuff tears. The gender of the patients doesn’t appear a discriminating factor. The age appears to influence only boundedly the clinical post-operative outcomes. In our opinion, the initial diagnoses is determinant: patients affected by systemic pathology, like rheumatoid arthritis, or by cuff tear obtain the least functional improvement and satisfaction; on the contrary, patients affected by primary and secondary degenerative joint diseases, post-traumatic cartilage lesions and avascular osteonecrosis of the humeral head obtain better results.
Correspondence should be addressed to Diane Przepiorski at ISTA, PO Box 6564, Auburn, CA 95604, USA. Phone: +1 916-454-9884; Fax: +1 916-454-9882; E-mail: ista@pacbell.net
