TY - JOUR
T1 - Primary shoulder arthroplasty using a custom-made hip-inspired implant for the treatment of advanced glenohumeral arthritis in the presence of severe glenoid bone loss
AU - Chammaa, Ramsey
AU - Uri, Ofir
AU - Lambert, Simon
N1 - Publisher Copyright:
© 2017 Journal of Shoulder and Elbow Surgery Board of Trustees
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background Total shoulder arthroplasty for end-stage glenohumeral arthritis with severe glenoid bone loss poses a unique challenge for shoulder surgeons. Current surgical solutions are limited and associated with high complication rates. We hypothesized that a custom-made computer-aided design–computer-aided manufacturing (CAD-CAM) total shoulder replacement (TSR; Stanmore Implants Worldwide, Elstree, UK) resembling a total hip prosthesis could offer a reliable alternative for this challenging subset of patients. Methods Thirty-seven patients with rotator cuff–deficient end-stage glenohumeral arthritis and severe glenoid bone loss (assessed as not amenable to treatment with standard anatomic or reverse total shoulder implants) were treated with the CAD-CAM TSR between 2006 and 2013. Clinical data were collected prospectively and analyzed at a mean follow-up of 5 years. Results Postoperatively, the pain level with activity decreased from 9.2 ± 1.7 to 2.4 ± 2.9 (P < .001). The Oxford Shoulder Score improved from 11 ± 8 points to 27 ± 11 points (P < .001), and the Subjective Shoulder Value (on a 0%-100% scale) improved from 23% ± 14% to 60% ± 24% (P < .001). Active forward elevation improved from 39° ± 23° to 63° ± 38° (P < .001), and external rotation improved from 6° ± 16° to 15° ± 17° (P = .001). Component revision was required in 6 of 37 patients (16%) (glenoid loosening in 1, humeral stem loosening in 3, periprosthetic fracture in 1, and prosthesis dislocation in 1). Conclusion The CAD-CAM TSR offers a reliable alternative for the treatment of end-stage glenohumeral arthritis with severe glenoid deficiency not amenable to standard anatomic or reverse total shoulder implants, with maintenance of significant pain relief and clinical-functional improvement at 5-year postoperative follow-up.
AB - Background Total shoulder arthroplasty for end-stage glenohumeral arthritis with severe glenoid bone loss poses a unique challenge for shoulder surgeons. Current surgical solutions are limited and associated with high complication rates. We hypothesized that a custom-made computer-aided design–computer-aided manufacturing (CAD-CAM) total shoulder replacement (TSR; Stanmore Implants Worldwide, Elstree, UK) resembling a total hip prosthesis could offer a reliable alternative for this challenging subset of patients. Methods Thirty-seven patients with rotator cuff–deficient end-stage glenohumeral arthritis and severe glenoid bone loss (assessed as not amenable to treatment with standard anatomic or reverse total shoulder implants) were treated with the CAD-CAM TSR between 2006 and 2013. Clinical data were collected prospectively and analyzed at a mean follow-up of 5 years. Results Postoperatively, the pain level with activity decreased from 9.2 ± 1.7 to 2.4 ± 2.9 (P < .001). The Oxford Shoulder Score improved from 11 ± 8 points to 27 ± 11 points (P < .001), and the Subjective Shoulder Value (on a 0%-100% scale) improved from 23% ± 14% to 60% ± 24% (P < .001). Active forward elevation improved from 39° ± 23° to 63° ± 38° (P < .001), and external rotation improved from 6° ± 16° to 15° ± 17° (P = .001). Component revision was required in 6 of 37 patients (16%) (glenoid loosening in 1, humeral stem loosening in 3, periprosthetic fracture in 1, and prosthesis dislocation in 1). Conclusion The CAD-CAM TSR offers a reliable alternative for the treatment of end-stage glenohumeral arthritis with severe glenoid deficiency not amenable to standard anatomic or reverse total shoulder implants, with maintenance of significant pain relief and clinical-functional improvement at 5-year postoperative follow-up.
KW - CAD-CAM shoulder
KW - Total shoulder arthroplasty
KW - custom shoulder implant
KW - glenoid bone loss
KW - glenoid deficiency
KW - hip-inspired shoulder replacement
KW - rotator cuff arthropathy
UR - http://www.scopus.com/inward/record.url?scp=84994353637&partnerID=8YFLogxK
U2 - 10.1016/j.jse.2016.05.027
DO - 10.1016/j.jse.2016.05.027
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C2 - 27522339
AN - SCOPUS:84994353637
SN - 1058-2746
VL - 26
SP - 101
EP - 107
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
IS - 1
ER -