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5-8 Year Results of Stemless Humeral Head Replacement: A Prospective Two-Center Study
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ASES Abstracts
failed in its use as a glenoid component for anatomic total shoulder arthroplasty. Failure of the first generation component was usually preceded by the appearance of intra-articular metallic debris. After redesign, it was reintroduced in 2009. This radiographic review evaluates the redesigned glenoid component after a minimum 2 year follow-up. Methods: 68 patients with 73 total shoulder arthroplasties using porous tantalum glenoid components were reviewed. 63 arthroplasties were available for follow-up at more than 2 years. A grading system for metallic debris formation was created by the senior author based on the failure of the previous generation of porous tantalum glenoid component. Radiographs were independently reviewed by two shoulder arthroplasty surgeons and their results were compared. Glenoid components were evaluated for signs of bone in-growth and metallic debris formation. Results: At minimum 2 year follow up (mean 43.5 months, range 24-73, SD 10.1), 63 of 73 (86%) arthroplasties were available for review. Radiographic evidence for bone in-growth was observed in 98.4% of the glenoid components. One component had early loosening and was revised. One patient died from unrelated causes. Nine patients were not available for follow up. Overall, 27 components (44%) showed evidence of metallic tantalum debris development, and the prevalence of metallic debris increased with the duration of follow-up. Eighteen components (58%) with a minimum 4 years follow-up showed evidence of debris formation. Additionally, the degree of metallic debris formation increased with follow-up duration. There were no component fractures or revisions for breakage in this series. Conclusion: The porous tantalum glenoid appears to have excellent bone integration and component fixation after 2 years. However, the development of metallic debris, increasing in both prevalence and degree over time, raises concern for potential failure of this glenoid component. Although there was no component breakage in this series at an average of 43.5 months post-op, longer follow-up is required.
17 5-8 YEAR RESULTS OF STEMLESS HUMERAL HEAD REPLACEMENT: A PROSPECTIVE TWO-CENTER STUDY Sven Lichtenberg, MD, Petra Magosch, MD, Lars J. Lehmann, MD, PhD, Peter Habermeyer, MD, Department of Orthopaedic and Trauma Surgery, University Medical Center, Mannheim, Germany; Department of Shoulder and Elbow Surgery, ATOS Clinic, Heidelberg, Germany Aim: The aim of the study was to evaluate the functional and radiological results of shoulder arthroplasty using a single type stemless humeral head implant with a minimum follow-up of five years. Material and Method: Since 2005 stemless shoulder arthroplasty was prospectively documented. For 97 patients (60 HSA, 37 TSA), with a mean age of 58 years at surgery, a mean clinical and radiological follow-up of 72 months (range, 5-8 years) is available. Indications for shoulder arthroplasty were in 53 cases primary osteoarthritis (OA), in 28 cases posttraumatic arthritis (PA), in 16 cases other indications. 48% of the patients had previous surgeries. The functional results were documented using the Constant-Score (CS). Results: The overall CS improved significantly from 41 points (P) pre-op to 66P post-op. Results for OA (mean-follow-up 67 months): - CS: 43P pre-op, 68P post-op - Active-flexion: 110 pre-op, 153 post-op - Active-abduction: 72 pre-op, 145 post-op - Active-ERO: 32 pre-op, 46 post-op Results for PA (mean-follow-up 77 months): - CS: 41P pre-op, 63P post-op - Active-flexion: 98 pre-op, 129 post-op - Active-abduction: 65 pre-op, 114 post-op - Active-ERO: 14 pre-op, 38 post-op Both patient groups showed a significant (p<0.05) improvement of all functional parameters. The postoperative CS showed no significant difference between both indications. Patients with OA achieved a significant better flexion (p¼0,013) and abduction (p¼0,008) post-op. Radiologically, 4.1% of the patients had an
J Shoulder Elbow Surg April 2015
incomplete radiolucent-line <1 mm of the humeral component. Stress-shielding under the superior part of the humeral component was observed in 36% without influencing shoulder function (CS with/without stress-shielding 65P each). One prosthetic loosening occurred, without revision until now. No implant failure was observed. The complication rate was 13.4%, revision rate was 8.2%. Reasons for revision/complication will be shown. Conclusions: The overall early functional results of the stemless HHR were comparable to the 3rd&4th generation of standard stemmed arthroplasty. Stress-shielding does not influence the functional result.
18 TOTAL SHOULDER ARTHROPLASTY FOR PRIMARY OSTEOARTHRITIS UTILIZING A MINI-STEM HUMERAL COMPONENT- MIDTERM RESULTS OF THE FIRST 100 CASES Elizabeth Gausden, MD, Samuel A. Taylor, MD, Joshua S. Dines, MD, Asheesh Bedi, MD, Christopher Chin, BS, Edward V. Craig, MD, Thomas L. Wickiwiecz, MD, David M. Dines, MD, Hospital for Special Surgery, New York, New York, USA Purpose: Total shoulder arthroplasty is a highly successful procedure for primary osteoarthritis. As indications favor younger patients, there has been a trend towards smaller bone preserving implants. This study sought to assess the midterm clinical results for mini-stem humeral implants. Methods: 100 consecutive patients with primary osteoarthritis who underwent anatomic total shoulder arthroplasty with humeral mini-stem and hybrid-pegged glenoid components were retrospectively reviewed. Outcome measures included clinical exam findings, University of California at Los Angeles (UCLA) Shoulder Score, and Constant-Murley Score. Standardized radiographs were used to assess implant position and assess for evidence of osteolysis and loosening. Results: 100 Shoulder replacements were done in 93 patients (F:46; M 47) The average age was 67.8 years (46-87 years). All patients were followed for an average of 3.6 years. 95% of patients were satisfied. Average UCLA and Constant-Murley scores were 27.5 and 91.1 respectively. 93% had good to excellent results. Average range of motion was 147.5 of forward elevation, 136.2 of abduction, and 61.2 of external rotation. There was no radiographic evidence of humeral component loosening or proximal osteolysis. 8 pateints had minimal lucent lines less than 1mm and all in fewer than 3 zones. There were 3 failures including 1 early infection and 2 cases of instability, all of which underwent revision procedures. Conclusions: The mid-term results of the initial patient cohort treated with a humeral mini-stem component with hybrid glenoid yielded excellent results with regard to subjective and objective outcome measures without evidence of implant loosening or osteolysis.
19 POST-OPERATIVE RESTORATION OF UPPER EXTREMITY MOTION AND NEUROMUSCULAR CONTROL DURING THE OVERHAND PITCH: EVALUATION OF TENODESIS AND REPAIR FOR SLAP TEARS Peter N. Chalmers, MD, Robert Trombley, BS, Johannes Cip, MD, Brett T. Monson, MA, Brian Forsythe, MD, Gregory P. Nicholson, MD, Charles A. Bush-Joseph, MD, Brian J. Cole, MD, MBA, Markus A. Wimmer, PhD, Anthony A. Romeo, MD, Nikhil N. Verma, MD, Rush University Medical Center, Chicago, Illinois, USA Background: Superior labral anterior-posterior (SLAP) tears are a common cause of shoulder pain and dysfunction in overhead throwers. Treatment outcomes remain unpredictable with a large percentage of athletes unable to return to sport. There is considerable debate about the optimal treatment between debridement, repair, and tenodesis. We hypothesized that operative treatment of SLAP tears with labral repair would result in more closely normal restoration of neuromuscular control and motion during the overhand pitch when compared to players managed with long head biceps (LHB) tenodesis. Methods: Eighteen pitchers including 7 normal controls, 6 players status-post SLAP repair, and 5 players status-post subpectoral biceps tenodesis (BT) underwent simultaneous surface
ASES Abstracts
failed in its use as a glenoid component for anatomic total shoulder arthroplasty. Failure of the first generation component was usually preceded by the appearance of intra-articular metallic debris. After redesign, it was reintroduced in 2009. This radiographic review evaluates the redesigned glenoid component after a minimum 2 year follow-up. Methods: 68 patients with 73 total shoulder arthroplasties using porous tantalum glenoid components were reviewed. 63 arthroplasties were available for follow-up at more than 2 years. A grading system for metallic debris formation was created by the senior author based on the failure of the previous generation of porous tantalum glenoid component. Radiographs were independently reviewed by two shoulder arthroplasty surgeons and their results were compared. Glenoid components were evaluated for signs of bone in-growth and metallic debris formation. Results: At minimum 2 year follow up (mean 43.5 months, range 24-73, SD 10.1), 63 of 73 (86%) arthroplasties were available for review. Radiographic evidence for bone in-growth was observed in 98.4% of the glenoid components. One component had early loosening and was revised. One patient died from unrelated causes. Nine patients were not available for follow up. Overall, 27 components (44%) showed evidence of metallic tantalum debris development, and the prevalence of metallic debris increased with the duration of follow-up. Eighteen components (58%) with a minimum 4 years follow-up showed evidence of debris formation. Additionally, the degree of metallic debris formation increased with follow-up duration. There were no component fractures or revisions for breakage in this series. Conclusion: The porous tantalum glenoid appears to have excellent bone integration and component fixation after 2 years. However, the development of metallic debris, increasing in both prevalence and degree over time, raises concern for potential failure of this glenoid component. Although there was no component breakage in this series at an average of 43.5 months post-op, longer follow-up is required.
17 5-8 YEAR RESULTS OF STEMLESS HUMERAL HEAD REPLACEMENT: A PROSPECTIVE TWO-CENTER STUDY Sven Lichtenberg, MD, Petra Magosch, MD, Lars J. Lehmann, MD, PhD, Peter Habermeyer, MD, Department of Orthopaedic and Trauma Surgery, University Medical Center, Mannheim, Germany; Department of Shoulder and Elbow Surgery, ATOS Clinic, Heidelberg, Germany Aim: The aim of the study was to evaluate the functional and radiological results of shoulder arthroplasty using a single type stemless humeral head implant with a minimum follow-up of five years. Material and Method: Since 2005 stemless shoulder arthroplasty was prospectively documented. For 97 patients (60 HSA, 37 TSA), with a mean age of 58 years at surgery, a mean clinical and radiological follow-up of 72 months (range, 5-8 years) is available. Indications for shoulder arthroplasty were in 53 cases primary osteoarthritis (OA), in 28 cases posttraumatic arthritis (PA), in 16 cases other indications. 48% of the patients had previous surgeries. The functional results were documented using the Constant-Score (CS). Results: The overall CS improved significantly from 41 points (P) pre-op to 66P post-op. Results for OA (mean-follow-up 67 months): - CS: 43P pre-op, 68P post-op - Active-flexion: 110 pre-op, 153 post-op - Active-abduction: 72 pre-op, 145 post-op - Active-ERO: 32 pre-op, 46 post-op Results for PA (mean-follow-up 77 months): - CS: 41P pre-op, 63P post-op - Active-flexion: 98 pre-op, 129 post-op - Active-abduction: 65 pre-op, 114 post-op - Active-ERO: 14 pre-op, 38 post-op Both patient groups showed a significant (p<0.05) improvement of all functional parameters. The postoperative CS showed no significant difference between both indications. Patients with OA achieved a significant better flexion (p¼0,013) and abduction (p¼0,008) post-op. Radiologically, 4.1% of the patients had an
J Shoulder Elbow Surg April 2015
incomplete radiolucent-line <1 mm of the humeral component. Stress-shielding under the superior part of the humeral component was observed in 36% without influencing shoulder function (CS with/without stress-shielding 65P each). One prosthetic loosening occurred, without revision until now. No implant failure was observed. The complication rate was 13.4%, revision rate was 8.2%. Reasons for revision/complication will be shown. Conclusions: The overall early functional results of the stemless HHR were comparable to the 3rd&4th generation of standard stemmed arthroplasty. Stress-shielding does not influence the functional result.
18 TOTAL SHOULDER ARTHROPLASTY FOR PRIMARY OSTEOARTHRITIS UTILIZING A MINI-STEM HUMERAL COMPONENT- MIDTERM RESULTS OF THE FIRST 100 CASES Elizabeth Gausden, MD, Samuel A. Taylor, MD, Joshua S. Dines, MD, Asheesh Bedi, MD, Christopher Chin, BS, Edward V. Craig, MD, Thomas L. Wickiwiecz, MD, David M. Dines, MD, Hospital for Special Surgery, New York, New York, USA Purpose: Total shoulder arthroplasty is a highly successful procedure for primary osteoarthritis. As indications favor younger patients, there has been a trend towards smaller bone preserving implants. This study sought to assess the midterm clinical results for mini-stem humeral implants. Methods: 100 consecutive patients with primary osteoarthritis who underwent anatomic total shoulder arthroplasty with humeral mini-stem and hybrid-pegged glenoid components were retrospectively reviewed. Outcome measures included clinical exam findings, University of California at Los Angeles (UCLA) Shoulder Score, and Constant-Murley Score. Standardized radiographs were used to assess implant position and assess for evidence of osteolysis and loosening. Results: 100 Shoulder replacements were done in 93 patients (F:46; M 47) The average age was 67.8 years (46-87 years). All patients were followed for an average of 3.6 years. 95% of patients were satisfied. Average UCLA and Constant-Murley scores were 27.5 and 91.1 respectively. 93% had good to excellent results. Average range of motion was 147.5 of forward elevation, 136.2 of abduction, and 61.2 of external rotation. There was no radiographic evidence of humeral component loosening or proximal osteolysis. 8 pateints had minimal lucent lines less than 1mm and all in fewer than 3 zones. There were 3 failures including 1 early infection and 2 cases of instability, all of which underwent revision procedures. Conclusions: The mid-term results of the initial patient cohort treated with a humeral mini-stem component with hybrid glenoid yielded excellent results with regard to subjective and objective outcome measures without evidence of implant loosening or osteolysis.
19 POST-OPERATIVE RESTORATION OF UPPER EXTREMITY MOTION AND NEUROMUSCULAR CONTROL DURING THE OVERHAND PITCH: EVALUATION OF TENODESIS AND REPAIR FOR SLAP TEARS Peter N. Chalmers, MD, Robert Trombley, BS, Johannes Cip, MD, Brett T. Monson, MA, Brian Forsythe, MD, Gregory P. Nicholson, MD, Charles A. Bush-Joseph, MD, Brian J. Cole, MD, MBA, Markus A. Wimmer, PhD, Anthony A. Romeo, MD, Nikhil N. Verma, MD, Rush University Medical Center, Chicago, Illinois, USA Background: Superior labral anterior-posterior (SLAP) tears are a common cause of shoulder pain and dysfunction in overhead throwers. Treatment outcomes remain unpredictable with a large percentage of athletes unable to return to sport. There is considerable debate about the optimal treatment between debridement, repair, and tenodesis. We hypothesized that operative treatment of SLAP tears with labral repair would result in more closely normal restoration of neuromuscular control and motion during the overhand pitch when compared to players managed with long head biceps (LHB) tenodesis. Methods: Eighteen pitchers including 7 normal controls, 6 players status-post SLAP repair, and 5 players status-post subpectoral biceps tenodesis (BT) underwent simultaneous surface