The Global Conservative Anatomic Prosthesis (Global CAP) is an uncemented press fit humeral resurfacing implant developed by DePuy. We report a single surgeon series of Global CAP prostheses implanted in Norwich. 103 procedures were carried out between 2006 and 2011, in 93 patients. Mean age was 72 years (range 43 to 90). Patients were followed up for a mean 8 months (range 0 to 56). Pre-operative Oxford shoulder scores were recorded in a preadmission clinic and an Oxford score questionnaire was sent to patients post-operatively in December 2011. The mean score preoperatively was 19, rising to 28 postoperatively. Two patients developed rotator cuff tears and have been revised to
We used an inverted shoulder arthroplasty in 43 consecutive patients with a mean age of 78 years (65 to 97) who had sustained a three- or four-part fracture of the upper humerus. All except two were reviewed with a mean follow-up of 22 months (6 to 58). The clinical outcome was satisfactory with a mean active anterior elevation of 97° (35° to 160°) and a mean active external rotation in abduction of 30° (0° to 80°). The mean Constant and the mean modified Constant scores were respectively 44 (16 to 69) and 66% (25% to 97%). Complications included three patients with reflex sympathetic dystrophy, five with neurological complications, most of which resolved, and one with an anterior dislocation. Radiography showed peri-prosthetic calcification in 36 patients (90%), displacement of the tuberosities in 19 (53%) and a scapular notch in ten (25%). Compared with conventional hemiarthroplasty, satisfactory mobility was obtained despite frequent migration of the tuberosities. However, long-term results are required before reverse shoulder arthroplasty can be recommended as a routine procedure in complex fractures of the upper humerus in the elderly.
