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Background: Total shoulder arthroplasty (TSA) is the preferred treatment for glenohumeral arthritis refractory to nonoperative measures. However, some surgeons have argued for a role for hemiarthroplasty (HA) in the setting of a smooth glenoid that articulates appropriately with the humeral head. The purpose of this study is to evaluate long-term revision rates and short-term postoperative complications in patients undergoing either HA or TSA for glenohumeral arthritis. Methods: A retrospective review of patients who underwent HA and TSA was conducted using a commercially available national database. Demographics, postoperative complications, risk factors, revision rates, and costs were analyzed using 2 sample t-tests, chi-squared tests, and multivariate logistic regressions. Results: Patients were stratified by operation: (1) HA (n = 1615) or 2) TSA (n = 7845). Patients undergoing primary TSA had higher rates of prior ipsilateral rotator cuff repair and corticosteroid injections. At 2 years, patients who underwent HA, 3.0% of patients had revision surgery, compared to 1.6% of patients who underwent TSA (P = .002); at 5 years, 3.7% of the HA cohort (P < .0001) had revision surgery, compared to 1.9% of patients who underwent TSA. Conclusions: Patients undergoing TSA or RTSA for glenohumeral arthritis had higher preoperative co-morbidities but had no difference in short-term complication rates with a lower risk of revision surgery at both 2-year and 5-year follow-up when compared to HA. Increasing age, female sex, hyperlipidemia, postoperative infection, shoulder instability, and thromboembolism all independently increased odds for revision shoulder arthroplasty for glenohumeral arthritis. Level of evidence Level: III.
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Background: Reverse shoulder arthroplasty is the mainstay of treatment for symptomatic irreparable rotator cuff tears in elderly patients without arthritis. However, this treatment incurs significant costs and is a major surgical undertaking. This study explores an alternative that involves the reconstruction of irreparable rotator cuff tears using an acellular dermal matrix in elderly patients without established joint arthritis. Methods: We prospectively evaluated the reconstruction of massive irreparable rotator cuff tears in 21 patients aged 68 years and over without radiographic glenohumeral joint osteoarthritis in whom conservative management had failed. A human dermal acellular matrix graft was used as a bridging graft for reconstruction. Pain scores, Oxford Shoulder Scores and ranges of movement were all assessed preoperatively and postoperatively. The mean follow-up period was 5.8 years (range 2.6 to 8.9 years). Results: Statistically significant (p < 0.05) improvements were observed in Oxford Shoulder Scores (mean preoperative score, 21; mean postoperative score, 46), pain scores (mean preoperative score, 6; mean postoperative score, 0) and ranges of movement. Patients also reported a high satisfaction rate with the procedure. Discussion: Human tissue matrix allografts could serve as a suitable option for the treatment of elderly patients with massive irreparable rotator cuff tears without arthritis.
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Shoulder pain is a common reason for a patient to see their primary care physician. This article focuses on the evaluation and management of 3 common shoulder disorders; rotator cuff disorders, acromioclavicular joint arthritis, and glenohumeral joint arthritis. The typical history and physical examination findings for each of these entities are highlighted, in addition to treatment options.