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Affection of glenoid wear on clinical results after humeral head replacement using a single prosthesis in cuff tear arthropathy with more than 8 years follow-up.

Authors:
Jun Kawamata Naoki Suenaga Naomi Oizumi Chika Yoshioka Naoki Miyoshi Isoya Goya

J Shoulder Elbow Surg 2022 Jun 15. Epub 2022 Jun 15.

Department of Orthopaedic Surgery, Nanbu Tokusyukai Hospital, Okinawa, Japan.

Background: Glenoid wear (GW) is a long-term complication after HHR, and one of the major reasons for revision surgery. This study evaluated GW after more than 8 years follow-up after HHR in patients with CTA using a modified classification of GW, to examine the relationship between GW and clinical outcomes, and identify risk factors for GW progression.

Methods: This retrospective case series study included 34 shoulders (13 male, 21 female; mean age at surgery: 70.9 years (range, 55-82 years)) that were monitored for more than 8 years after HHR in patients with CTA. Patients were monitored for a mean of 10.3 years (range, 8.1-13.2 years). GW was classified using plain radiographs as Grade 0, no remarkable postoperative changes; Grade 1, narrower than preoperative glenohumeral joint space; Grade 2, contact between glenoid and humeral head prosthesis; and Grade 3, glenoid erosion. Grade 3 cases were classified as subtypes 3A: partial erosion of anterior glenoid, 3B: partial erosion of superior glenoid, and 3C: concentric erosion of glenoid. Clinical outcomes, including range-of-motion (ROM) (active flexion, active external rotation), and postoperative pain scores (Constant score) were compared between groups 0-2 (including Grade 0, 1, 2 shoulders) and group 3 (Grade 3 shoulders), and among Grade 3 subtypes. Age, sex, preoperative ROM, preoperative pain, and number of ruptured tendons were analyzed as possible risk factors for progression to grade 3.

Results: Final GW grades were 0, 1, 2 and 3 in three, 10, six and 15 shoulders, respectively (3A: 2, 3B: 6, 3C: 7). Group 3 had lower pain scores than groups 0-2 (10.7±6.2 vs. 14.2±1.9, p=.044), and limited active flexion (108.2±42.3° vs. 140.6±26.7°, p=.041). In subtype comparison, group 3B had lower pain scores (7.0±6.7 vs. 15.0±0.0, p=.007) and limited active flexion (80.0±26.2° vs. 140.8±27.5°, p=.010) compared to 3C. Limited preoperative active external rotation was an individual risk factor for grade 3 GW (OR 0.93, 95%CI 0.88-0.99, p=.009).

Conclusions: In the long term (more than 8 years) after HHR with tendon transfers in patients with CTA, patients who develop grade 3C GW achieve pain relief finally even without revision surgery, whereas grade 3B GW is associated with persistent pain and might require revision surgery.

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http://dx.doi.org/10.1016/j.jse.2022.05.013DOI Listing
June 2022

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