HA, TSA: show similar mid-term results

A study comparing hemiarthroplasty (HA) and total shoulder arthroplasty (TSA) revealed equivalent results at a minimum 5-year follow-up, according to the authors of Paper 280.

In this retrospective study, researchers compared mid-term results of 50 HAs and 47 TSAs performed between August 1990 and November 1997 at a single center. Hemiarthroplasty was performed where subluxation was absent or moderate, where glenoid morphology was normal or restorable by reaming and where bone quality was adequate. A total shoulder arthroplasty was performed otherwise.

The mean age was of all patients (35 females and 62 males) was 57 years (range: 27 to 78 years). Patients with primary and secondary osteoarthritis were included, but those with inflammatory arthritis and acute fractures were excluded. Mean follow-up was 7.5 years for HA patients and 6.2 years for TSA patients, with a minimum 5-year follow-up.

Outcome data were derived from patient self-assessment questionnaires, including the American Shoulder and Elbow Surgeon (ASES) score, and the validated Simple Shoulder Test (SST). Visual analog scales (VAS) were used preoperatively and postoperatively to evaluate pain, shoulder comfort (arm at rest and during sleep), ability to use the arm (work or play), overall shoulder function and overall quality of life.

Preoperatively, the TSA group had poorer scores than the HA group, on all VAS scales, the SST, and two of three range-of-motion measures.  Postoperatively, the groups were equivalent.  At two years, no statistical difference or trend was observed for any VAS scale.

At last follow-up, results remained equivalent for VAS scales and SST. The HA group had a mean SST score of 9.4; the TSA group had a mean SST score of 9.5 (p=0.83). Forward flexion was superior in the TSA group (mean of 133,compared to a mean of 120 in the HA group, p=0.04). External rotation did not differ, but internal rotation was superior in the HA group. Every HA patient reached a spinal segment as high or higher than the median segment reached by the TSA patients.

Because this data was drawn from a patient population limited to primary and secondary osteoarthritis and a single institution, the authors note that results may not be applicable to patients with acute fractures, rheumatoid arthritis or cuff tear arthroplasty or other patient populations. However, they say that “the results provide evidence that hemiarthroplasty achieves equivalent results to total shoulder arthroplasty at 5- to 10-year follow-up in osteoarthritic patients that are selected and managed according to the criteria set forward in this report.”

The authors included: Michael A Wirth, MD; Carleton Southworth, MS, and Charles A. Rockwood Jr., MD—all of San Antonio, Texas. All authors serve as consultants to Johnson & Johnson; Dr. Rockwood also receives royalties from Johnson & Johnson.


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