Prosthetic shoulder arthroplasty in young patients provides substantial pain relief and improvement in active range of motion, irrespective of diagnosis and glenoid management.
Prosthetic shoulder arthroplasty (PSA) reliably improves comfort and function in patients with glenohumeral arthritis although for osteoarthritis the results following total shoulder arthroplasty (TSA) are superior to those following hemiarthroplasty (HA). Long-term outcomes data are available for patients undergoing PSA who are 50-55 years old or less, but it remains difficult to extrapolate to the youngest patients. The purpose of this study is to report on the outcomes, stratified by diagnosis, following PSA in patients who are 40 years old or less and the hypothesis is that TSA provides better clinical outcomes and durability, compared with HA. Methods: All PSAs performed by the senior author in patients 40 years old or less between 2008 and 2015 were considered for this study. Diagnosis was stratified as: chondrolysis, primary or secondary osteoarthritis, rheumatoid arthritis, and osteonecrosis. Surgeries were stratified as either resurfacing or stemmed HA, or TSA. Patients underwent standardized measurement of active range of motion, as well as, self-assessed outcomes evaluation using VAS-pain, SST, and ASES scores, both preoperatively and at final follow-up.
Twenty-nine of 788 (3.7%) PSAs were performed in patients 40 years old or less. Two were excluded because of concomitant salvage surgery for shoulder instability and 2 were lost to follow-up, leaving 25 shoulders in 24 patients available for follow-up at a mean 3.9 years postoperatively. Ten shoulders underwent TSA and 15 underwent HA. Fourteen shoulders underwent PSA for chondrolysis, and 20 patients had undergone previous surgery (range 1-7 surgeries). Fifteen patients were male and mean age at arthroplasty was 31.2 years (range 19-40). Patients undergoing resurfacing HA were significantly younger (29.2 vs. 34.6, p<0.05) than those undergoing TSA; those undergoing PSA for chondrolysis were also younger (27.7 vs. 34.6, p<0.001). Range of motion improved following PSA: mean active forward elevation improved from 111° to 138°, active abduction improved from 97° to 133°, active external rotation at the side improved from 31° to 47°, and active internal rotation improved from L5 to T12 spinous process (p<0.0001 for all). Mean VAS-pain score improved from 6.7 to 2.7 (p<0.001), mean SST improved from 2.9 to 8.6 (p<0.0001), and mean ASES score improved from 37 to 73 (p<0.001). Resurfacing HA and TSA patients had similar pre-and postoperative range of motion and outcomes scores, and patients undergoing PSA for chondrolysis had higher final VAS pain scores (3.3 vs. 1.5, p<0.08) than other patients. Three patients underwent revision of resurfacing HA to TSA for painful glenoid arthrosis during the study period.
and Conclusions: This study demonstrates that PSA in young patients provides substantial improvement in active range of motion, irrespective of diagnosis and glenoid management. Furthermore, residual shoulder pain is common in these patients, which dampers the outcomes scores. The 3 failed resurfacing HAs are concerning so that this procedure should be considered only after shared decision-making and counsel about the risk of early revision to TSA. Longer follow-up of this cohort will be needed to determine the role, if any, for resurfacing HA in young patients.