Shoulder
Shoulder arthroplasty in patients aged fifty-five years or younger with osteoarthritis

https://doi.org/10.1016/j.jse.2010.05.006Get rights and content

Background

The younger patient with glenohumeral arthritis presents a challenge because of concerns about activity and frequency of failure. The purpose of this study was to define the results, complications, and frequency of revision surgery in this group.

Materials and methods

Between 1986 and 2005, 46 total shoulder arthroplasties and 20 hemiarthroplasties were performed in 63 patients who were aged 55 years or younger and had chronic shoulder pain due to glenohumeral osteoarthritis. All 63 patients had complete preoperative evaluation, operative records, and minimum 2-year follow-up (mean, 7.0 years) or follow-up until revision.

Results

Nine shoulders underwent a revision operation. The implant survival rate was 92% (95% confidence interval, 77%-100%) at 10 years for total shoulder arthroplasty and 72% (95% confidence interval, 54%-97%) for hemiarthroplasty (Kaplan-Meier result). Patients who underwent total shoulder arthroplasty had less pain (P = .01), greater active elevation (P = .05), and higher satisfaction (P = .05) at final follow-up compared with those who underwent hemiarthroplasty. Complete radiographs were available for 47 arthroplasties with a minimum 2-year follow-up or follow-up until revision (mean, 6.6 years). More than minor glenoid periprosthetic lucency or a shift in component position was present in 10 of 34 total shoulder arthroplasties. Moderate to severe glenoid erosion was present in 6 of 13 hemiarthroplasties.

Conclusions

This study indicates that there is intermediate- to long-term pain relief and improvement in motion with shoulder arthroplasty in young patients with osteoarthritis. These results favor total shoulder arthroplasty in terms of pain relief, motion, and implant survival.

Section snippets

Materials and methods

The Mayo Clinic Institutional Review Board gave approval for this study (No. 09-004605). No external source of funding was used for any aspect of this study.

Complications and revisions

Five perioperative complications occurred in the forty-six shoulders undergoing total shoulder arthroplasty. These included 3 brachial plexopathies, 2 of which completely resolved; 1 minimally displaced fracture of the glenoid seen on postoperative radiographs treated in a spica cast; and 1 lower extremity deep vein thrombosis. There were 3 perioperative complications that occurred in the 20 shoulders receiving hemiarthroplasty: 1 wound hematoma requiring evacuation, irrigation, and debridement

Discussion

There have been few data available to guide clinical decision making for the young patient with glenohumeral osteoarthritis. Much of the previous work has addressed shoulder arthroplasty for osteoarthritis regardless of age2, 6, 8, 13, 15, 23 or arthroplasty in the young patient with varied diagnoses.3, 19, 20 Recent articles have reported favorable short-term to midterm results for total shoulder arthroplasty in young to middle-aged patients with osteoarthritis14 or chondrolysis.11 In

Conclusions

  • 1.

    Shoulder arthroplasty for osteoarthritis in patients aged 55 years or younger is rarely indicated, and rates of revision and component loosening are high.

  • 2.

    Better pain relief, motion, and patient satisfaction were seen with total shoulder arthroplasty versus hemiarthroplasty.

Disclaimer

Robert Cofield, MD, receives royalties from Smith & Nephew and DJO/Aircast (Vista, CA). John W. Sperling, MD, receives royalties from Biomet. However, no outside funding was used for any part of this study.

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    (2005)
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