Stem exchange offers less pain for elective hemiarthroplasty revision patients

SAN DIEGO — Though stem exchange did not affect outcomes in revision hemiarthroplasty performed as treatment for humeral head fracture, it was found to decrease the improvement of pain in cases of elective hemiarthroplasty revision, according to a study presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

“Unsatisfactory results are seen in 30% to 50% of patients following revision total shoulder arthroplasty in previous studies,” lead author Adam Sassoon, MD, said. “Unfortunately, due to the small numbers of patients in these studies it is hard to clearly identify specific factors associated with poor results and poor satisfaction.”

Thus, Sassoon said, the aims of his study were to characterize the outcomes of revision total shoulder arthroplasty for painful humeral head replacement in a large series, and then to assess the effect of stem exchange on revision total shoulder arthroplasty outcome.

A retrospective review

Adam Sassoon

Sassoon’s group retrospectively reviewed 102 shoulders that underwent revision total shoulder arthroplasty for treatment of glenoid arthrosis from 1982 to 2005. The study worked with a minimum of 2 years follow-up.

According to the study abstract, 68 of the cases underwent initial humeral head replacements for non-fracture-related arthritis. The remaining 34 cases were matters of fracture care. Complexity was used to stratify the revision procedures so comparative analyses could be performed.

Pain, range of motion, patient satisfaction, Neer ratings and survivorship were all utilized as clinical outcomes to assess stem revision as a variable, Sassoon reported.

The impact of stem exchange

The team found that with a mean 7-year follow-up, 59 of the 102 revision total shoulder arthroplasty cases ultimately required stem exchange. Facilitation of exposure at the time of revision total shoulder arthroplasty was reportedly the most common reason for stem exchange, Sassoon noted, adding that 38 of the exchanges were performed in patients who initially underwent elective humeral head replacement. The remaining 21 patients with exchanges, he added, underwent humeral head replacement due to their fractures.

“Looking at our results for all comers, what we found was that there was significant improvement in postoperative pain and range of motion with respect to abduction and external rotation,” Sassoon said. “We also noted an 80% 10-year survival rate free from revision; however despite these clinical gains, 59% of our patients had an unsatisfactory modified Neer score.”

The team also found that stem exchange did not actually impact postoperative pain, range of motion, Neer rating or survivorship for the elective humeral head replacement group. Preoperative to postoperative improvement in pain scores, however, was reported as less in patients who actually required stem revision.

Reference:

Sassoon A, Rhee PC, Schleck CD, et al. Stem exchange: Implications in revision total shoulder arthroplasty for the painful hemiarthroplasty. Paper #364. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.

Disclosure: Sassoon has no relevant financial disclosures.

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