Humeral head resurfacing was proposed as a treatment for glenohumeral arthrosis in an attempt to preserve the original anatomy and avoid humeral head resection. Preservation of humeral head maintained the native inclination, offset, head shaft angle, and version of humerus [
The primary aim of our study was to report the results of humeral resurfacing arthroplasty in a consecutive series of patients at a district general hospital practice.
Twenty-one consecutive patients underwent shoulder resurfacing (Aequalis, Tornier, USA) between October 2007 and November 2009 for symptomatic end-stage glenohumeral arthrosis. Clinical examination and radiographic evidence were used as the benchmark for diagnosis. Patient demographics, duration of surgery, intraoperative findings, and complications were prospectively recorded. Only patients with a minimum followup of two years were included for analyses. Of the 21 patients, one patient had worsening of symptoms and underwent revision to a stemmed total shoulder replacement in less than 2 years, one patient died of unrelated cause, and in one patient the humeral head collapsed at the time of impaction of the definitive component and therefore was converted to a stemmed hemiarthroplasty intraoperatively. Therefore 18 patients with a mean followup of 36.3 months (range 24–54 months) were included in the study. There were 6 men and 12 women with a mean age of 75.1 years (range 58–91 years, 95% CI of the SD was 70.8 to 79.4), and there were 7 right and 11 left shoulders (Table
Spreadsheet.
No. | Age | Sex | Side | Length of GA in minutes | Hospital stay in days | Followup in months | Preoperative OSS | Final OSS | Change in OSS | Complication |
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1 | 80 | M | L |
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Nil |
2 | 82 | M | R |
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Nil |
3 | 83 | F | R |
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Nil |
4 | 80 | F | L |
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Nil |
5 | 63 | M | R |
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Nil |
6 | 69 | M | R |
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Nil |
7 | 78 | F | L |
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Nil |
8 | 77 | F | R |
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Nil |
9 | 82 | F | L |
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Nil |
10 | 64 | F | L |
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Nil |
11 | 91 | F | L |
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Nil |
12 | 80 | F | R |
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Nil |
13 | 80 | F | L |
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Nil |
14 | 72 | F | L |
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Nil |
15 | 58 | M | L |
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Nil |
16 | 64 | M | L |
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Adhesive capsulitis |
17 | 72 | F | R |
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Nil |
18 | 78 | F | L |
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Nil |
All patients were operated on in the beach chair position under general anaesthesia and an interscalene nerve block. The shoulder was exposed by a deltopectoral approach with the upper third of subscapularis and the joint capsule reflected in one layer. The inferior capsule was released of the humeral neck whilst protecting the axillary nerve. The humeral head was exposed by external rotation and adduction of the arm. The cartilage of humeral head and glenoid were inspected for wear, and osteophytes were excised from the head of the humerus. The rotator cuff was inspected for its integrity, and either a normal appearance or partial tear was recorded. Any inflammatory pathology of the rotator interval, integrity of the labrum and the long tendon of the biceps brachii and loose bodies in the inferior recess were recorded. The size of the humeral head was measured with the sizing guide. A guide wire was then introduced in the centre of the humeral head which was reamed to the measured size, and trial component inserted after a cruciate keel made a foot anchor in the cancellous bone of the humeral head. Soft tissue releases were undertaken, and stability and range of movement of the shoulder were assessed with trial implant in situ. Definitive component was then impacted. Subscapularis tendon and joint capsule were repaired using the tendon-to-tendon technique. The operation was performed by the senior author or by an orthopaedic trainee under direct supervision of the senior author. The mean duration of anaesthesia that included surgical time was 112 minutes (range 75–150 minutes, median 120 minutes). The postoperative regime was the same for all patients. This included monitoring of postoperative pain and neurovascular status, two further doses of IV cefuroxime 1.5 gm each at 8 and 16 hours, a check X-ray of the shoulder’s anteroposterior and lateral views, a sling to be worn for comfort, no external rotation beyond neutral for 3 weeks and no active external rotation for 6 weeks, physiotherapy advice at discharge, and a physiotherapy followup at 3 weeks postoperatively. Anteroposterior, axillary, and lateral radiographs were taken before and after the operation.
Clinical outcome of the operation was assessed by patients’ self-reported Oxford shoulder score (OSS) for pain. This consisted of 12 questions involving activities of daily routine. It has a best possible score of 48 and the worst score of 0 [
The median duration of hospital stay was one day (mean 2 days, range 1–8 days). One patient complained of chest pain postoperatively and stayed for 8 days in the hospital. She was diagnosed to have a triple vessel coronary disease, which delayed her discharge due to investigative procedures. She later underwent a coronary artery angioplasty. The pre-operative mean OSS of 15 (range 3–29, 95% CI of the SD was 10.6 to 19.4) improved by 19.5 points to a final mean OSS of 34.5 (range 6–47, 95% CI of the SD was 29.3 to 39.7). The improvement of OSS was highly significant with a two-tailed
15 patients (83.3%) had greater than 11-point improvement of OSS (Table
Change in Oxford shoulder score.
Decrease in OSS | Number of patients |
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−3 | 1 |
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Improvement in OSS | Number of patients |
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0–4 | 2 |
5–10 | 0 |
11–20 | 4 |
21–30 | 10 |
31–40 | 1 |
Of the excluded patients, one had an intraoperative collapse of the humeral head while impaction of the definitive implant and therefore was converted to a stemmed hemiarthroplasty. One patient had poor initial result from the resurfacing procedure and was revised to total shoulder replacement within the first two years. He had an initial OSS of 10 that only improved to 11 after resurfacing. X-rays at 10 months were suggestive of glenoid erosion. He made a significant improvement to a final OSS of 30 at one year after total shoulder replacement.
None of the patients were lost to followup. There were no wound healing problems, infection, deep vein thrombosis, pulmonary embolism, and neurovascular deficits.
Over the past twenty years, shoulder resurfacing arthroplasty has gained popularity as an alternative to conventional shoulder arthroplasty for the treatment of glenohumeral arthropathy [
Most patients (94.5%) were very or fairly pleased with the operation similar to the 90% satisfaction rate reported by Huguet et al. [
The limitations of our study are due to smaller number of patients and early followup. Long-term results of this implant are not yet known. However, given the available data, our study shows very good results with Aequalis shoulder resurfacing prosthesis. It was not the purpose of this study to compare shoulder resurfacing with stemmed shoulder replacements, and no overall consensus was reached favoring one over the other. This may need a prospective, randomized, long-term study in the future.
This is an IV, retrospective study on a consecutive series of patients.