William N. Levine, MD, Charla R. Fischer, MD, Duong Nguyen, MD, Evan L. Flatow, MD, Christopher S. Ahmad, MD, and Louis U.

Transcription

1 e164(1) COPYRIGHT Ó 2012 BY THE JOURAL OF BOE AD JOIT SURGERY, ICORPORATED Long-Term Follow-up of Shouler Hemiarthroplasty for Glenohumeral William. Levine, MD, Charla R. Fischer, MD, Duong guyen, MD, Evan L. Flatow, MD, Christopher S. Ahma, MD, an Louis U. Bigliani, MD Investigation performe at the Center for Shouler, Elbow an Sports Meicine, Columbia University Meical Center, ew York, Y Backgroun: There is major controversy surrouning the use of hemiarthroplasty as compare with total shouler arthroplasty for glenohumeral osteoarthritis, an long-term clinical outcomes of hemiarthroplasty are lacking. Methos: Of a cohort of thirty patients (thirty-one shoulers) who were treate with hemiarthroplasty for glenohumeral osteoarthritis an followe longituinally at our institution, twenty-five were available for long-term follow-up; five ie, an one refuse to participate. Three of the five patients who ie ha revision arthroplasty before eath, an the ata from those three were therefore inclue in the final follow-up (final follow-up ata therefore inclue twenty-seven patients an twenty-eight shoulers). Follow-up through phone conversations an postal mail surveys inclue the following: Short Form-36, American Shouler an Elbow Surgeons (ASES) shouler outcome score, EuroQol, Simple Shouler Test, moifie eer Score, an a unique, valiate self-aministere range-of-motion questionnaire. Correlations between clinical outcome an age, type of glenoi wear, an cause of osteoarthritis were etermine. Results: The average follow-up was 17.2 years (range, thirteen to twenty-one years). There were eight revisions (three of fifteen shoulers with concentric glenois, an five of sixteen shoulers with eccentric glenois). For those shoulers not revise, the average ASES score was (range, to 91.67). Overall, active shouler forwar elevation an external rotation with the arm at 90 of abuction increase from 104 preoperatively to (range, 45 to 180 ) an 20.7 to 61.0 (range, 30 to 90 ), respectively (p < 0.05), at the time of final follow-up. Of those who require revision arthroplasty, the average patient age at the time of the inex proceure was 51.0 years (range, twenty-six to eighty-one years), while those not requiring revision average 57.1 years (range, twenty-seven to sixty-three years). The overall eer satisfaction rating was 25%. The average eer score an eer rating for unrevise cases were significantly higher for concentric glenoi wear compare with eccentric glenoi wear (p = an p = 0.001, respectively). Patients who ha concentric glenoi wear ha higher EuroQol scores (p = 0.020). The average eer scores were (range, forty-seven to seventy-eight) for primary osteoarthritis an (range, forty to seventy-seven) for seconary osteoarthritis (p = 0.036). Conclusions: Only 25% of patients with glenohumeral osteoarthritis treate with shouler hemiarthroplasty are satisfie with their outcome at an average of seventeen years after the operation. Patients with concentric glenoi wear an primary osteoarthritis have better outcomes than those with eccentric glenoi wear an seconary osteoarthritis o, but patients in both groups experience eterioration of results over time. Level of Evience: Therapeutic Level IV. See Instructions for Authors for a complete escription of levels of evience. of the glenohumeral joint is a life-altering isease, the treatment for which was ramatically change in the 1970s with the introuction of shouler arthroplasty. Initially, humeral hea replacement alone was introuce for the treatment of glenohumeral osteoarthritis. Goo results were reporte, with most patients experiencing pain relief an return of shouler function 1. Yet some patients ha a slow recovery of strength an ha continuing shouler fatigability. Disclosure: one of the authors receive payments or services, either irectly or inirectly (i.e., via his or her institution), from a thir party in support of any aspect of this work. One or more of the authors, or his or her institution, has ha a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomeical arena that coul be perceive to influence or have the potential to influence what is written in this work. o author has ha any other relationships, or has engage in any other activities, that coul be perceive to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitte by authors are always provie with the online version of the article. J Bone Joint Surg Am. 2012;94:e164(1-7)

2 e164(2) T HE J OURAL OF B OE &JOIT SURGERY JBJS. ORG LOG-TERM F OLLOW-UP OF S HOULDER H EMIARTHROPLASTY FOR G LEOHUMERAL O STEOARTHRITIS Glenoi resurfacing was later introuce by eer, who foun that patients ha superior pain relief an greater patient satisfaction compare with humeral hea replacement alone 2.Inications for humeral hea replacement alone were questione Stuies showe that, in comparison with total shouler replacement, humeral hea replacement le to better outcomes in patients with severe rotator cuff isease, persistent instability, an lack of glenoi bone stock 12,13, in part ue to the early loosening an failure of the glenoi component that occurre after total shouler replacement 6, Glenoi component failure has been a major concern in shouler arthroplasty. Progressive raiolucent lines are commonly foun on postoperative raiographs of patients who have unergone glenoi resurfacing; however, the mere presence of these raiolucent lines is not always inicative of glenoi component failure requiring revision 6,8,14,16. Torchia et al. 18 showe that glenoi loosening was associate with pain, yet Boy et al. foun no association with progressive glenoi loosening an pain 6. The conition of the glenoi is one of many factors influencing the ecision-making to resurface the glenoi uring shouler arthroplasty. Other critical factors inclue patient age, the conition an integrity of the rotator cuff, an the presence of inflammatory arthritis. There is no formula to etermine which patients shoul receive a hemiarthroplasty an which shoul receive a total shouler arthroplasty. These factors have to be counterbalance with the concern that exists regaring the urability of shouler hemiarthroplasty. Other alternatives that have been use to avoi prosthetic glenoi implantation inclue biologic resurfacing of the glenoi with interpositional graft (fascia lata, capsule, or Achilles tenon) 19, arthroscopic glenoplasty 20,an glenoi reaming ( ream an run ) 21. There are risks associate with all of these, an, although limite short-term success has been reporte, none has emonstrate long-term urability. The raiographic appearance an clinical features of the glenoi are critical in etermining whether humeral hea replacement alone will be successful. We previously reporte that patients with concentric glenois ha better outcomes than those with eccentric glenois 22. This fining suggeste that eccentric glenoi wear may be a relative contrainication for isolate humeral hea replacement. Later stuies further valiate these results, incluing the stuy by Iannotti an orris, which showe that patients with eccentric glenoi wear ha better results with total shouler arthroplasty than they i with humeral hea replacement 23. The purpose of the current stuy was to report on the long-term outcomes of patients treate with hemiarthroplasty for glenohumeral osteoarthritis an to compare the results with those from our previous stuy, which ha much shorter follow-up 22. The hypothesis was that, irrespective of glenoi type, the outcomes of hemiarthroplasty woul eteriorate over time an patients with eccentric glenoi wear woul fare worse. Materials an Methos In this retrospective stuy, we reviewe the forty-two patients with glenohumeral osteoarthritis who ha been treate with shouler hemiarthroplasty at our institution between June 1990 an December In our previously reporte series 22, thirty (thirty-one shoulers) of those forty-two patients were available for miterm follow-up at 7.9 years. From this original cohort, twentyseven patients (twenty-eight shoulers) were available for the current follow-up at 17.2 years after the initial hemiarthroplasty. Five of the original patients ha ie, but three ha unergone revision arthroplasty prior to eath an were inclue in our follow-up ata. One patient refuse to participate in follow-up ue to continue pain. We obtaine informe consent from participating patients, an our institutional review boar approve this stuy. There were fifteen men an fifteen women. ine patients (ten shoulers) were treate for primary osteoarthritis, incluing seven men (one receive bilateral treatment) an two women. Twenty-one patients (twenty-one shoulers) were treate for seconary osteoarthritis, incluing eight men an thirteen women. Of the patients with seconary osteoarthritis, seven ha osteoarthritis as a result of prior trauma, four ha osteoarthritis cause by a prior glenohumeral instability repair (three Putti-Platt an one Magnuson-Stack), seven ha osteonecrosis of the humeral hea, an three evelope chronic arthritis as a result of other reasons (e.g., neonatal septic arthritis). All surgical proceures were one through a stanar eltopectoral approach an with use of anterior an inferior capsular release to allow for stable external rotation after repair of the subscapularis tenon. There was no intraoperative evience of posterior glenohumeral subluxation. Four subacromial ecompressions were performe, an no rotator cuff tears were present. All patients receive a eer II prosthesis (3M, St. Paul, Minnesota), an all patients followe a stanar rehabilitation program starting immeiately after the operation. The conition of the glenohumeral joint was evaluate preoperatively on axillary raiographs an then confirme at the time of surgery for the type of glenoi wear. At the time of this stuy, avance imaging stuies such as compute tomography (CT) an/or magnetic resonance imaging (MRI) were not routinely orere prior to performing shouler arthroplasty. We now routinely perform preoperative CT on all shouler arthroplasty patients to better assess the glenoi wear, as axillary raiographs can be misleaing. Aitional intraoperative factors were note, such as presence of scarring causing contractures, the presence of humeral osteophytes, an the presence of intraarticular loose boies. Although no patients ha rotator cuff tears, fraying of the tenons was evaluate. The type of glenoi wear was categorize as either type I or type II, consistent with categories use in our initial stuy. Type-I glenois ha a concentric cartilage egeneration pattern that create a concentric osseous surface without flattening or significant bone loss. Type-II glenois were no longer concentric as a result of uneven bone loss in aition to the cartilage surface loss 22. At the time of follow-up examination, patients were evaluate with a variety of outcome tools, incluing the Short-Form 36 (SF-36), the EuroQol, the moifie eer score, the American Shouler an Elbow Surgeons (ASES) ata sheet, the Simple Shouler Test, a visual analog scale (VAS) for pain, an assessment of subjective satisfaction, an a valiate, patient self-assessment range-of-motion questionnaire 24. (Please see the Appenix for a escription of the moifie eer rating scale, the EuroQol, an the patient self-assessment range-of-motion questionnaire.) The range-of-motion questionnaire is a valiate self-reporting tool that allows patients to accurately etermine their range of motion. This ha been proven to be highly effective an accurate. Regaring the eer rating scale, excellent an goo were inclue in the satisfactory group, an fair an poor were inclue in the unsatisfactory group. Subjective satisfaction was evaluate on a scale of very satisfie, satisfie, or issatisfie. Statistical Methos While the purpose of our stuy was to report the long-term results after humeral hemiarthroplasty, we also analyze the effect of glenoi wear pattern an surgical inication. One null hypothesis state that there is no ifference in long-term outcomes of shouler hemiarthroplasty in patients with concentric an eccentric glenoi wear. The secon null hypothesis was that patients with primary osteoarthritis have similar long-term outcomes after shouler hemiarthroplasty as patients whose osteoarthritis is seconary to trauma. We performe Stuent t tests to etermine the significance of the ifferences seen in each group.

3 e164(3) T HE J OURAL OF B OE &JOIT SURGERY JBJS. ORG LOG-TERM F OLLOW-UP OF S HOULDER H EMIARTHROPLASTY FOR G LEOHUMERAL O STEOARTHRITIS TABLE I Patient Demographics by Subgroup Primary Seconary Male patients (no. of shoulers) 7 (8) 8 (8) Female patients (no. of shoulers) 2 (2) 13 (13) Age at surgery (yr) Length of follow-up (yr) Revisions 2 6 Concentric glenoi (type I) 7 8 Eccentric glenoi (type II) 3 13 Inications for hemiarthroplasty cause by instability repair 4 Posttraumatic osteoarthritis 7 Osteonecrosis of the humeral hea 7 Other causes of osteoarthritis 3 Source of Funing There were no external sources of funing provie for this stuy. Results The loss of patients between the short-term (i.e., twentynine months) follow-up of thirty-one shoulers an the long-term (i.e., 17.2 years) follow-up of twenty-eight shoulers i not prouce ifferences in the patient emographics. The average length of follow-up of these patients was 17.2 years (range, thirteen to twenty-one years). The average age of the patients at the time of initial hemiarthroplasty was 55.5 years (range, twenty-six to eighty-one years; stanar eviation, 12.7). The average age at the time of the most recent follow-up of 17.2 years was years (range, to eighty-five years). The pertinent emographic ata is liste in Table I. The overall eer scores showe 25% (seven of twentyeight) satisfactory results an 75% (twenty-one of twenty-eight) unsatisfactory results. Eight shoulers (29%) ha unergone revision arthroplasty an were consiere as having a poor outcome. In total, there were four (14%) excellent results, three (11%) goo results, three (11%) fair results, an eighteen (64%) poor results. Of the twelve shoulers with type-i glenoi wear, five (42%) ha satisfactory results an seven (58%) ha unsatisfactory results. Of the sixteen shoulers with type-ii glenoi wear, two (13%) ha satisfactory results an fourteen (88%) ha unsatisfactory results. The outcomes were consiere satisfactory in four (44%) of the nine shoulers with primary osteoarthritis an three (16%) of the nineteen shoulers with seconary osteoarthritis. The results are summarize in Table II along with the publishe results from the 2.4-year follow-up an the unpublishe results from the mirange 7.9-year follow-up. While the overall results were poor, a comparison of the eer scores accoring to glenoi wear type an osteoarthritis type showe significant ifferences. The average moifie eer score, eer rating, an eer satisfaction for type-i glenois were significantly better than they were for type-ii glenois (p = 0.015, 0.001, an 0.045, respectively) (Table III). Only the eer score was significantly better for patients with primary osteoarthritis than it was for patients with seconary osteoarthritis (65.29 [range, forty-seven to seventy-eight] compare with [range, forty to seventy-seven], respectively; p = 0.036) (Table III). Overall, shouler motion was significantly improve from baseline. Both active forwar elevation an external rotation with the arm in 90 of abuction improve significantly (104 to [range, 45 to 180 ] an 20.7 to 61.0 [range, 30 to 90 ], respectively; p < 0.05) from the time that the preoperative baseline measurements were mae until the time of final follow-up. The average level of active internal rotation i not improve significantly. Shouler motion was obtaine at the latest follow-up with a valiate self-assessment form that was not available at the time of the initial surgery. At the time of long-term follow-up, the overall pain scores remaine low at 2.20 (range, 0 to 8). The shouler motion an pain outcomes showe more improvement for patients with type-i glenois than for patients with type-ii glenois. The average forwar elevation, external rotation with the arm in 90 of abuction, TABLE II Patient Satisfaction Accoring to the eer Criteria At 2.4 Years Patient Satisfaction At 7.9 Years* At 17.2 Years Overall 74% 61% 25% Concentric glenoi (type I) 84% 67% 42% Eccentric glenoi (type II) 63% 56% 12% Primary osteoarthritis 80% A 44% Seconary osteoarthritis 71% A 16% *A = not available.

4 e164(4) T HE J OURAL OF B OE &JOIT SURGERY JBJS. ORG LOG-TERM F OLLOW-UP OF S HOULDER H EMIARTHROPLASTY FOR G LEOHUMERAL O STEOARTHRITIS TABLE III Average Moifie eer Scores by Patient Subgroup Concentric Glenoi (Type I) Eccentric Glenoi (Type II) Primary Seconary eer score (range) (47 to 78) (40 to 77) eer rating Goo Poor Fair Poor eer satisfaction Satisfie Unsatisfie Satisfie Unsatisfie TABLE IV Average Range of Motion an Pain by Patient Subgroup Concentric Glenoi (Type I) Eccentric Glenoi (Type II) Primary Seconary Forwar elevation External rotation with arm in of abuction Internal rotation L5 level L5 level L5 level L5 level Visual analog scale pain score TABLE V Average Subjective Outcome Scores by Subgroup* Concentric Glenoi (Type I) Eccentric Glenoi (Type II) Primary Seconary ASES SF EuroQol Simple Shouler Test Patient-reporte satisfaction Very satisfie Satisfie Very satisfie Satisfie *ASES = American Shouler an Elbow Surgeons shouler outcome score, SF-36 = Short-Form 36. an internal rotation were better for patients with type-i glenois, but the ifference was not significant. The average active internal rotation was to the 5th lumbar vertebra for both type-i an type-ii glenois. Pain scores were also very similar between the two groups (Table IV). Shouler motion outcomes with regar to forwar elevation an external rotation with the arm in 90 of abuction were significantly better for patients with primary osteoarthritis than for patients with seconary osteoarthritis (p = an 0.004, respectively) (Table IV). The long-term patient-centere outcome scores for the patients with nonrevise shoulers were compare with the preoperative an short-term scores of patients from the same cohort. The average ASES scores for the nonrevise shoulers at the time of long-term follow-up showe improvement over the short-term follow-up scores. The overall outcome scores for the twenty nonrevise shoulers at the time of long-term follow-up were as follows: ASES score, (range, to 91.67); SF-36 score, (range, 30 to 98.33); EuroQol score, (range, to 0.841); an the Simple Shouler Test score, 8.15 (range, 4 to 12). Although the outcome measures were greater for patients with type-i glenois than for those with type-ii glenois, there was a significant ifference only for the EuroQol score (p = 0.020). Subjective patient satisfaction varie accoring to glenoi type, with type-i glenois associate with an average rating of very satisfie an type-ii glenois associate with an average rating of satisfie (Table V). Patients who ha primary osteoarthritis also fare better with regar to outcome scores an patient satisfaction than i patients who ha seconary osteoarthritis (Table V). The overall revision rate was 29% (eight of twenty-eight shoulers). Shoulers with a type-i glenoi were revise at a rate of 25% (three of twelve shoulers), an shoulers with a type-ii glenoi were revise at a rate of 31% (five of sixteen shoulers) (Fig. 1). Patients who unerwent revision ha an average age of 51.0 years (range, twenty-six to eighty-one years) at the time of the inex proceure. The patients who i not unergo revision ha an average age of 57.1 years (range,

5 e164(5) T HE J OURAL OF B OE &JOIT SURGERY JBJS. ORG LOG-TERM F OLLOW-UP OF S HOULDER H EMIARTHROPLASTY FOR G LEOHUMERAL O STEOARTHRITIS Fig. 1 Survivorship of hemiarthroplasty implants over time. twenty-seven to sixty-three years) at the time of surgery. Seven patients (eight shoulers) unerwent revision. Of these seven, one patient who ha unergone bilateral hemiarthroplasties for the treatment of primary osteoarthritis unerwent revision proceures an receive a total shouler replacement for the right shouler at four years an for the left shouler at twelve years. Arthroscopic ebriement of the glenohumeral joint was performe in the right shouler two years after the initial surgery, an the hemiarthroplasty implant was converte to a total shouler prosthesis two years later. The inication for both revisions was a painful hemiarthroplasty. Another hemiarthroplasty patient who ha unergone prior glenohumeral instability repair with a Putti-Platt proceure unerwent revision to a total shouler prosthesis three years after the hemiarthroplasty proceure. One patient who initially ha humeral hea osteonecrosis unerwent revision to a total shouler prosthesis ten years after the hemiarthroplasty. A patient who ha instability after trauma unerwent revision to a total shouler replacement at two years an then unerwent total shouler revision arthroplasty eleven years after the hemiarthroplasty. One patient who initially ha osteonecrosis unerwent revision hemiarthroplasty for a superiorly subluxating humeral hea at nine years after the hemiarthroplasty. Another patient ha pain an unerwent revision prior to his eath six years after the initial hemiarthroplasty. The final patient unerwent revision to a total shouler arthroplasty seventeen years after the original hemiarthroplasty. Discussion The controversy regaring choice of arthroplasty for the treatment of glenohumeral osteoarthritis continues. Longterm follow-up results of our original cohort of patients show eteriorating outcomes for shoulers that unergo humeral hea replacement for the treatment of primary an seconary glenohumeral arthritis. Overall patient function ecrease in all patients, regarless of glenoi type or presenting iagnosis. The eer satisfaction score ecrease from 74% at 2.4 years, to 61% at 7.9 years, an ultimately to 25% at 17.2 years of follow-up. There have been several stuies that have reporte on the long-term results after humeral hea replacement. Rispoli et al. followe forty-nine patients an fifty-one humeral hea replacements with an average follow-up of 11.3 years 12.They foun a revision rate of 25%, which is consistent with our revision rate of 29%. Fifty-eight percent of patients in this stuy ha a satisfactory or excellent result accoring to a moifie eer rating system. Wirth et al. followe forty-three patients at an average of 7.5 years after hemiarthroplasty 13. All parameters measure were better at the two-year postoperative evaluation. However, only the Simple Shouler Test showe a significant retaine high value at two an seven years. This stuy confirms our finings that shouler function improves in the first few years after hemiarthroplasty but then steaily eclines with long-term follow-up.

6 e164(6) T HE J OURAL OF B OE &JOIT SURGERY JBJS. ORG LOG-TERM F OLLOW-UP OF S HOULDER H EMIARTHROPLASTY FOR G LEOHUMERAL O STEOARTHRITIS There are many stuies that report the superior miterm to long-term results of total shouler arthroplasty compare with humeral hea replacement for glenohumeral osteoarthritis 3,6-10,16,25. Ewars et al. reporte on the largest series to ate (601 total shouler arthroplasties an eighty-nine humeral hea replacements) an note that total shouler arthroplasty ha significantly better results than humeral hea replacement across all parameters 8. Orfaly et al. followe patients with humeral hea replacement an total shouler arthroplasty for an average of 4.3 years 10 an foun that while pain scores between the hemiarthroplasty an total shouler arthroplasty groups were similar, total shouler arthroplasty le to a greater preoperative to postoperative increase in ASES scores. Sperling et al. reporte their results at an average of 16.8 years of follow-up after humeral hea replacement an total shouler arthroplasty 3. Patients who ha unergone humeral hea replacement ha 60% unsatisfactory results an a revision rate of 18% at ten years an 25% at twenty years. The revision rates following total shouler arthroplasty were much lower, with 3% at ten years an 16% at twenty years. Some authors have postulate that a benefit of humeral hea replacement in young patients is that it allows for a simple conversion to total shouler arthroplasty if that proceure becomes necessary in the future. One of our stuy patients exemplifie how ifficult conversion can be: first he unerwent a humeral hea replacement that faile; then he require a complex conversion to total shouler arthroplasty, which also faile; an finally he unerwent a re-revision total shouler arthroplasty less than two years later. In aition to anecotal evience, several stuies have shown the ifficulty of preicting outcomes following revision conversion arthroplasty. Sperling an Cofiel followe eighteen patients who ha unergone conversion of humeral hea replacement to total shouler replacement 26. At an average follow-up of 5.5 years, they emonstrate a reuction in pain an an improvement in function after conversion to total shouler arthroplasty, but seven patients continue to have unsatisfactory results. In another stuy, Carroll et al. 7 also showe similar results. Sixteen consecutive patients unerwent revision to total shouler arthroplasty at an average of 3.5 years after initial humeral hea replacement. At an average of 5.5 years of follow-up, 47% of patients ha an unsatisfactory outcome. These two stuies illustrate that conversion of a humeral hemiarthroplasty to total shouler arthroplasty is not straightforwar an can result in limite improvement. After our initial stuy with an average of 2.4 years of follow-up 22, other stuies confirme that patients with concentric glenois have better outcomes than patients with eccentric glenois after humeral hea replacement. Iannotti an orris investigate preoperative characteristics that preicte a better postoperative outcome in both humeral hemiarthroplasty an in total shouler arthroplasty 23. Their cohort inclue 128 patients, twenty-nine of whom ha eccentric glenois. When compare with patients with eccentric glenois who ha humeral hea replacement, patients with eccentric glenois who unerwent total shouler arthroplasty ha better results with regar to pain, satisfaction, quality of life, an ASES scores. Hettrich et al. reporte similar results in seventy-one shoulers in sixty-eight patients at an average follow-up of forty-nine months, showing that, for shoulers without glenoi erosion, patient outcomes as measure by SF-36 an the Simple Shouler Test were better 17. Hasan et al. examine preoperative characteristics that le to the failure of sixty-four hemiarthroplasties an seventy-four total shouler arthroplasties 16, fining that 42% of patients with faile hemiarthroplasties ha substantial glenoi erosion. Our current stuy confirms these results with regar to ecrease satisfaction in patients with eccentric glenoi wear. The current stuy has several limitations. It is a retrospective cohort stuy an oes not have control groups, ranomization, or blining. The small patient cohort is another limitation. We may have been able to etect more significant ifferences in patient outcome if we ha starte with a larger sample size. Lastly, because many of the patients ha seconary osteoarthritis, the finings of this stuy cannot be compare with the finings of previous stuies that evaluate only primary glenohumeral osteoarthritis or ranomize clinical trials that compare humeral hea replacement with total shouler replacement. In aition, univariate analysis oes not allow efinitive interpretation of the relationship between glenoi morphology an the etiology of osteoarthritis as they are not inepenent variables. Despite these limitations, the major strength of this stuy was the ability to longituinally follow the original cohort for almost two ecaes. Our ata is in accorance with the literature that questions the use of humeral hea replacement as the inex proceure of choice for the treatment of glenohumeral arthritis. In aition to our results, many stuies have shown poor results in long-term follow-up of humeral hea replacement. When comparing total shouler arthroplasty with humeral hea replacement, the results favor the long-term results for total shouler replacement. Many authors have cite the ability of converting humeral hea replacements to total shouler replacement as an inication for hemiarthroplasty as first-line treatment for younger patients. However, the results of conversions are poor, an the long-term outcomes following total shouler replacement are superior. In summary, hemiarthroplasty for glenohumeral osteoarthritis is associate with poor urability an ecreasing survivorship with long-term follow-up. Patients with concentric glenoi wear an patients with eccentric glenoi wear both emonstrate lower patient outcomes over time. However, patients with eccentric glenois ha even poorer results than those with concentric glenois with longer-term follow-up. Base on our experience, we prefer total shouler replacement to hemiarthroplasty for the surgical management of glenohumeral osteoarthritis in shoulers with an intact rotator cuff. Appenix A escription of the moifie eer rating scale, the EuroQol, an the patient self-assessment range-of-motion questionnaire is available with the online version of this article as a ata supplement at jbjs.org. n

7 e164(7) T HE J OURAL OF B OE &JOIT SURGERY JBJS. ORG LOG-TERM F OLLOW-UP OF S HOULDER H EMIARTHROPLASTY FOR G LEOHUMERAL O STEOARTHRITIS William. Levine, MD Charla R. Fischer, MD Duong guyen, MD Evan L. Flatow, MD Christopher S. Ahma, MD Louis U. Bigliani, MD Center for Shouler, Elbow an Sports Meicine, Columbia University Meical Center, 622 West 168th Street, PH-1117, ew York, Y aress for W.. Levine: wnl1@columbia.eu References 1. eer CS 2n. Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am Jan;56(1): eer CS 2n, Watson KC, Stanton FJ. Recent experience in total shouler replacement. J Bone Joint Surg Am Mar;64(3): Sperling JW, Cofiel RH, Rowlan CM. Minimum fifteen-year follow-up of eer hemiarthroplasty an total shouler arthroplasty in patients age fifty years or younger. J Shouler Elbow Surg ov-dec;13(6): Sperling JW, Cofiel RH, Rowlan CM. eer hemiarthroplasty an eer total shouler arthroplasty in patients fifty years ol or less. Long-term results. J Bone Joint Surg Am Apr;80(4): Bohsali KI, Wirth MA, Rockwoo CA Jr. Complications of total shouler arthroplasty. J Bone Joint Surg Am Oct;88(10): Boy AD Jr, Thomas WH, Scott RD, Slege CB, Thornhill TS. Total shouler arthroplasty versus hemiarthroplasty. Inications for glenoi resurfacing. J Arthroplasty Dec;5(4): Carroll RM, Izquiero R, Vazquez M, Blaine TA, Levine W, Bigliani LU. Conversion of painful hemiarthroplasty to total shouler arthroplasty: long-term results. J Shouler Elbow Surg ov-dec;13(6): Ewars TB, Kaakia R, Boulahia A, Kempf JF, Boileau P, émoz C, Walch G. A comparison of hemiarthroplasty an total shouler arthroplasty in the treatment of primary glenohumeral osteoarthritis: results of a multicenter stuy. J Shouler Elbow Surg May-Jun;12(3): Gartsman GM, Roey TS, Hammerman SM. Shouler arthroplasty with or without resurfacing of the glenoi in patients who have osteoarthritis. J Bone Joint Surg Am Jan;82(1): Orfaly RM, Rockwoo CA Jr, Esenyel CZ, Wirth MA. A prospective functional outcome stuy of shouler arthroplasty for osteoarthritis with an intact rotator cuff. J Shouler Elbow Surg May-Jun;12(3): Pearl ML, Romeo AA, Wirth MA, Yamaguchi K, icholson GP, Creighton RA. Decision making in contemporary shouler arthroplasty. Instr Course Lect. 2005; 54: Rispoli DM, Sperling JW, Athwal GS, Schleck CD, Cofiel RH. Humeral hea replacement for the treatment of osteoarthritis. J Bone Joint Surg Am Dec;88(12): Wirth MA, Tapscott RS, Southworth C, Rockwoo CA Jr. Treatment of glenohumeral arthritis with a hemiarthroplasty: a minimum five-year follow-up outcome stuy. J Bone Joint Surg Am May;88(5): Baumgarten KM, Lashgari CJ, Yamaguchi K. Glenoi resurfacing in shouler arthroplasty: inications an contrainications. Instr Course Lect. 2004;53: Boy AD Jr, Thornhill TS. Surgical treatment of osteoarthritis of the shouler. Rheum Dis Clin orth Am Dec;14(3): Hasan SS, Leith JM, Campbell B, Kapil R, Smith KL, Matsen FA 3r. Characteristics of unsatisfactory shouler arthroplasties. J Shouler Elbow Surg Sep-Oct;11(5): Hettrich CM, Welon E 3r, Boorman RS, Parsons IM 4th, Matsen FA 3r. Preoperative factors associate with improvements in shouler function after humeral hemiarthroplasty. J Bone Joint Surg Am Jul;86(7): Torchia ME, Cofiel RH, Settergren CR. Total shouler arthroplasty with the eer prosthesis: long-term results. J Shouler Elbow Surg ov-dec;6(6): Krishnan SG, owinski RJ, Harrison D, Burkhea WZ. Humeral hemiarthroplasty with biologic resurfacing of the glenoi for glenohumeral arthritis. Two to fifteen-year outcomes. J Bone Joint Surg Am Apr;89(4): O Driscoll SW. Arthroscopic glenoiplasty an osteocapsular arthroplasty for avance glenohumeral osteoarthritis. Rea at the 67 th Annual Meeting of the American Acaemy of Orthopaeic Surgeons; 2000 Mar 18; Orlano, FL. 21. Clinton J, Franta AK, Lenters TR, Mounce D, Matsen FA 3r. onprosthetic glenoi arthroplasty with humeral hemiarthroplasty an total shouler arthroplasty yiel similar self-assesse outcomes in the management of comparable patients with glenohumeral arthritis. J Shouler Elbow Surg Sep-Oct;16(5): Epub 2007 May Levine W, Djurasovic M, Glasson JM, Pollock RG, Flatow EL, Bigliani LU. Hemiarthroplasty for glenohumeral osteoarthritis: results correlate to egree of glenoi wear. J Shouler Elbow Surg Sep-Oct;6(5): Iannotti JP, orris TR. Influence of preoperative factors on outcome of shouler arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am Feb; 85-A(2): Carter CW, Levine W, Kleweno CP, Bigliani LU, Ahma CS. Assessment of shouler range of motion: introuction of a novel patient self-assessment tool. Arthroscopy Jun;24(6): Epub 2008 Mar Verborgt O, El-Abia R, Gazielly DF. Long-term results of uncemente humeral components in shouler arthroplasty. J Shouler Elbow Surg May-Jun; 16(3 Suppl):S13-8. Epub 2006 Oct Sperling JW, Cofiel RH. Revision total shouler arthroplasty for the treatment of glenoi arthrosis. J Bone Joint Surg Am Jun;80(6):860-7.