Comparison of 5-year results of hemiarthroplasty versus anatomic total shoulder arthroplasty in patients under 40 years old

Abstract

Background

End-stage glenohumeral joint arthritis in young patients is difficult to manage due to increased physical demands and the need for prolonged implant longevity. Because of this, many surgeons prefer hemiarthroplasty (HA) over traditional anatomic total shoulder arthroplasty (TSA). This study aimed to compare the implant survivorship and patient-reported outcomes of HA versus TSA performed in patients under 40 years old.

Methods

This study was a retrospective analysis of patients at a single institution who underwent HA or TSA at age 40 or younger with at least 5-year follow-up from their index surgery or until documented implant failure. Preoperative data collected included demographic variables, number of prior surgeries, and indication for shoulder arthroplasty. Postoperative data collected included implant survivorship, range of motion, pain visual analoge scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores.

Results

The final analysis included 18 patients who underwent HA and 45 patients who underwent TSA. The average follow-up period was 7.8 ± 2.8 years among HA patients versus 9.6 ± 3.9 among TSA patients. Post-traumatic arthritis was the most common indication for both HA (39%) and TSA groups (47%). Five (21.7%) HA patients underwent revision, most commonly for glenoid wear. Thirteen (28.9%) TSA patients were revised, most commonly for rotator cuff failure. Among revision cases, the mean time to revision was 6.2 ± 5.5 years for HA patients and 8.6 ± 6.0 years for TSA patients (p = 0.521). There were no significant differences between the cohorts for revision rate (p = 0.577) and the 5-year Kaplan–Meier survival rate (88.9% for HA vs. 93.3% for TSA, p = 0.364). There were no significant differences in postoperative ASES, SANE, and VAS between the two cohorts (p > 0.05).

Conclusion

HA and TSA yielded comparable implant survivorship and patient outcomes in patients under the age of 40 at 5-year follow-up. Although glenoid arthrosis remains a concern, HA should not be excluded as a surgical choice for younger patients and should be considered on a case-by-case basis.

Level of Evidence

Level III—Retrospective Cohort Study

Keywords

Total shoulder arthroplasty shoulder hemiarthroplasty implant survivorship shoulder arthritis shoulder replacement

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