Eccentric glenoid wear does not influence patient reported outcomes and complication rates following humeral head resurfacing.
Humeral head resurfacing (HHR) is a less invasive arthroplasty technique that allows patient-specific reconstruction, preserved bone stock and a less invasive procedure to the traditional total shoulder arthroplasty (TSA) or stemmed hemiarthroplasty used for glenohumeral osteoarthritis. We investigated the mid- to long-term outcomes of HHR using validated patient-reported outcome (PRO) measures. We hypothesized that patients with eccentric glenoid wear would have significantly lower PRO scores and higher rates of complications than those with concentric wear patterns.
A retrospective review was performed on patients who underwent HHR at our institution between 2000 and 2014 by four different sports medicine fellowship trained orthopedic surgeons. PRO data were collected by administering a questionnaire containing the American Shoulder and Elbow Society (ASES) score, the Brophy activity survey, the short-form of the Disabilities of the Arm, Shoulder and Hand (quickDASH) survey, and general shoulder function and demographic questions. Complications were defined as the need for revision surgery or re-operation. Pre-operative glenoid wear pattern was classified according to the Walch classification, based on either magnetic resonance imaging (MRI) or computed tomography scan. Previous study had reported inter-rater MRI agreement of the 3 category Walch classifications among four orthopedic resident and sports medicine fellows as moderate, with ? value of 0.59 (Kopka, 2017). The PRO scores were then stratified by the Walch classification. Chi-square and one-way ANOVA were used for non-parametric and parametric data, respectively. Significance was defined as p < 0.05.
A total of 79 shoulders (76 patients) had complete imaging and PRO data for analyses. The follow up period from operation to the completion of PRO questionnaire ranged from 2.1 to 8.3 years, with a mean of 5.3 years. Twenty-eight glenoids were classified as Walch A, 44 as Walch B, and 7 as Walch C. There were no differences among the groups in age, gender, body mass index (BMI), prior history of rotator cuff dysfunction, prior non-arthroplasty shoulder surgery, laterality, surgeon, follow-up period, and the imaging modality used to classify the Walch system (p > 0.05). According to the PRO-data, there were no differences among the groups with regards to current or night pain, visual analog scores (VAS), narcotic usage, ASES pain, function, and total scores, quickDASH, Brophy, and satisfaction/success rates. Complications rates (rates?) were also similar (p > 0.05). However, there was a significant difference in subjective shoulder value (SSV, p = 0.047). Patients with Walch category B had a higher SSV (77.1 ± 20.0) than those with category A (61.8 ± 34.8), and C (61.7 ± 20.7).
Pre-operative glenoid wear pattern does not appear to influence patient reported outcomes and complications rates following humeral head resurfacing.
Reference: Kopka, M., et al. “Can glenoid wear be accurately assessed using x-ray imaging? Evaluating agreement of x-ray and magnetic resonance imaging (MRI) Walch classification.” J Shoulder Elbow Surg (2017) 26, 1527–1532.