Humeral head resurfacing is associated with less pain and clinically equivalent functional outcomes compared with stemmed hemiarthroplasty at mid-term follow-up

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 27; no. 10; pp. 3203 - 3211
• Main Authors: Fourman, Mitchell S., Beck, Andrea, Gasbarro, Gregory, Irrgang, James J., Rodosky, Mark W., Lin, Albert
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2019; Springer Nature B.V
• Subjects: Aged; Cross-Sectional Studies; Demographics; Demography; Equivalence; Female; Follow-Up Studies; Hemiarthroplasty; Humans; Humeral Head - surgery; Humerus; Male; Medicine; Medicine & Public Health; Middle Aged; Motion detection; Orthopedics; Osteoarthritis - surgery; Pain; Patient Satisfaction; Patients; Range of Motion, Articular; Resurfacing; Shoulder; Shoulder Joint - surgery; Surfacing; Surgery; Surgical outcomes; Treatment Outcome; Humeral head resurfacing; Mid-term follow-up; Rotator cuff dysfunction; Shoulder arthroplasty; Hemiarthroplasty; Patient-reported outcomes; Shoulder osteoarthritis
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-019-05382-w

Purpose
Humeral head resurfacing (HHR) is a less invasive, anatomic alternative to the conventional stemmed hemiarthroplasty in patients in whom isolated humeral head replacement is preferred. It was hypothesized that, in a mid-term cross-sectional subjective outcome analysis, HHR would have equivalent patient-reported and functional outcomes to stemmed hemiarthroplasty (HA).
Methods
A total of 213 HHR and 153 HA procedures were performed at a single academic institution from 2000 to 2014. Of these, 106 HHR and 47 HA patients corresponding with 120 HHR and 55 HA shoulders responded to a survey that collected patient demographics, surgical outcomes, patient satisfaction, and self-reported range of motion scores using both bespoke and validated metrics.
Results
Follow-up was longer in the HA group (9.4 ± 3.4 vs. 5.2 ± 1.8 years,
p
 < 0.0001). Self-reported range of motion was equivalent between groups. Surgery was perceived as helpful following 76.7% of HHRs and 78.2% of HAs (
p
 > 0.99). The ASES pain subscore was significantly worse in the HA group (25.2 ± 29.5 vs. 38.5 ± 12.7 after HHR,
p
 < 0.0001), which translated into worse ASES total scores (45.1 ± 14.8 HA vs. 52.2 ± 23.7 HHR,
p
 < 0.05). These findings were equivocal in responses received 2–8 years vs. ≥ 8 years after surgery.
Conclusions
Indications should be equivocal; humeral head resurfacing is a viable alternative to hemiarthroplasty, with equivalent patient satisfaction and reduced pain in the mid-term post-operative period.
Level of evidence
III.