Aims

To assess the extent of osteointegration in two designs of shoulder resurfacing implants. Bony integration to the Copeland cylindrical central stem design and the Epoca RH conical-crown design were compared.

Resurfacing of the humeral head is commonly used within the UK to treat osteoarthritis (OA) of the shoulder. We present the results of a small prospective randomised study of this procedure using the Global CAP prosthesis with two different coatings, Porocoat and DuoFix hydroxyapatite (HA). We followed two groups of ten patients with OA of the shoulder for two years after insertion of the prosthesis with tantalum marker beads, recording pain, Constant–Murley and American Shoulder and Elbow Surgeons (ASES) outcome scores, and using radiostereometric analysis to assess migration. The outcomes were similar to those of other series, with significant reductions in pain (p = 0.003) and an improvement in the Constant (p = 0.001) and ASES scores (p = 0.006). The mean migration of the prosthesis three months post-operatively was 0.78 mm (0.51 to 1.69) and 0.72 mm (0.33 to 1.45) for the Porocoat and DuoFix groups, respectively. Analysis of variance indicated that the rate of migration reached a plateau after three months post-operatively in both groups. At follow-up of two years the mean migration was 1 mm (sd 1 (0.25 to 3.32)); in the Porocoat group and 0.8 mm (sd 0.4 (0.27 to 1.45)) in the DuoFix HA group. Significant migration of the prosthesis was seen in one patient who had received an anterior humeral bone graft. This prosthesis was later revised after 2.7 years.

The addition of a coating of HA to the sintered surface does not improve fixation of this prosthesis.

Cite this article: Bone Joint J 2014;96-B:1077–81.

Introduction: Shoulder surface replacement arthroplasty has been established for several decades as a mean to restore comfort and function of the shoulder for many afflictions that derange the normal anatomy. The surface replacement may offer some advantages over the stemmed prostheses. Purpose: The purpose of the study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with bony defects of the humeral head. Patients and Methods: The study was conducted on 18 patients (2 patients with chronic posterior dislocation, 8 patients with AVN, 8 patients with posttraumatic head necrosis) with bony head defects that were operated on between 1999 and 2006. The patients were followed up clinically and radiologically for a mean of 24.8 months (range, 10–78 months). There were 8 female and 10 male shoulders. The mean age was 55.3 years (range, 27–71). The clinical assessment was performed with the Constant score. Results: The constant score significantly improved from a mean of 14.83 points preoperatively to 64.34 points postoperatively. The average pain score increased from 0.3 points to 9.8 points. The average ROM score increased from 8.21 points to 23.21 points. The humeral offset increased from 22.3 mm to 28.8 mm. Conclusion: The shoulder surface replacement arthroplasty shows good mid-term results in patients with bony defects

Introduction: Shoulder surface replacement arthroplasty has been established for several decades as a mean to restore comfort and function of the shoulder for many afflictions that derange the normal anatomy. The surface replacement may offer some advantages over the stemmed prostheses. Purpose: The purpose of the study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with a degenerative arthritis. Patients and Methods: The study was conducted on 76 patients with degenerative joint disease of the shoulder that were operated on between 1999 and 2006. The patients were prospectively followed up clinically and radiologically for a mean of 26.2 months (range, 9–80 months). There were 41 female and 35 male shoulders. The mean age was 64.4 years (range, 54–86). The mean operative time was 42 minutes (range, 27–62 minutes). The clinical assessment was performed with the Constant score Results: The constant score significantly improved from a mean of 16.32 points preoperatively to 68.72 points postoperatively. The average pain score increased from 0.2 points to 10.2 points. The average ROM score increased from 9.22 points to 24.73 points. The humeral offset increased from 24.2mm to 29.2mm. Conclusion: The shoulder surface replacement arthroplasty shows good mid-term results in patients with degenerative shoulder disease

Introduction: Glenohumeral arthritis with a massive rotator cuff tear is a devastating condition that seriously compromises the comfort and function of the shoulder. Cuff tear arthropathy presents a unique surgical challenge and many arthroplasty options were used for its treatment. The purpose of this study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with cuff tear arthropathy and intact subscapularis function.

Patients and Methods: The study was conducted on twenty five shoulders in twenty five patients with cuff tear arthropathy with the subscapularis tendon still intact. The patients were prospectively followed up clinically and radiologically for a mean of 26 months (range, 15–38 months). There were 16 female and 9 male shoulders. The mean age was 69.04 years (range,53–83years). The mean operative time was 38 minutes (range, 28–56minutes). The clinical assessment was performed with the Constant score.

Results: The constant score significantly improved from a mean of 14.04 points preoperatively to 53.17 points postoperatively. Of the patients, 88% considered the shoulder to be much better or better as a result of the operation.

Radiologically, the humeral offset, the lateral gleno-humeral offset (coracoid base to the greater tuberosity), height of center of instant rotation and the acromio-humeral distance were significantly increased. No intra-or postoperative complications encountered.

Conclusion: Our early results with the use of Copeland surface replacement in selected cases with cuff tear arthropathy were encouraging. The patients showed significant clinical (pain and range of motion) and radiological improvements. Moreover, if the surface replacement were to fail for any reason, it can be revised to a reverse prosthesis type as there is no lack of bone stock.

Purpose: The purpose of the study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with two main indications. Patients and Methods: The study was conducted on fifty shoulders in fifty patients between 2003 and 2005; 17 patients suffered from rotator cuff pathology. The patients were prospectively followed up clinically and radiologically for a mean of 12.7 months (range, 6–30 months). There were 30 female and 20 male shoulders. The mean age was 66.63 years (range, 21–85). The mean operative time was 44.6 minutes (range, 29–62 minutes). The clinical assessment was performed with the Constant score. Results: The constant score significantly improved from a mean of 15.52 points preoperatively to 57.02 points postoperatively. Of the patients, 96% considered the shoulder to be much better or better as a result of the operation. The Constant-Score improved in the group with degenerative arthritis from 16.32 point pre- to 62.25 postoperatively. In rotator cuff arthropathy the score improved from 14.19 to 53.06. Radiologically, the humeral offset, the lateral gleno-humeral offset (coracoid base to the greater tuberosity) as well as the acromiohumeral distance were significantly increased. No intra-or postoperative complications encountered. Conclusion: We conclude that the shoulder surface replacement arthroplasty allows good conservation of the bone stock and avoiding the complications encountered with the stemmed prostheses. In patients with rotator cuff arthropathy there are two main indications:. - patients below the age of 70, in order to avoid complications of the reverse prosthesis. - patients with still a goof active range of motion