Relevant differences in postttraumatic and degenerative shoulder hemiarthroplasty (a mid-term follow-up)

Introduction: In a comparative study, mid-term findings after posttraumatic and degenerative hemiprosthetic shoulder joint replacement were analyzed a nd compared with current reports in the literature. Methods: The patient sa mple in the retrospective study consisted of 20 patients with proximal frac tures of the humeral head (x = 64 years) and 6 patients (x = 61 years) with degenerative shoulder joint disease. In 14 patients the humeral head was r eplaced as a primary procedure at < 4 weeks after the trauma and in 6 patie nts as a secondary treatment at > 4 weeks. The follow-up period was 38-41 m onths on average. Evaluation was based on the Constant Score, subjective as sessment by the patient, and conventional radiographs. Results: After postt raumatic shoulder replacement, the patients achieved a Constant Score of 65 (+/- 19) and after degenerative replacement 74 (+/- 34) points. In the pos ttraumatic group, the Constant Score after primary implantation was better than after secondary implantation (68 +/- 16 versus 59 +/- 15 points). Afte r posttraumatic replacement, the only improvement over time was in pain lev els (p < 0.05). 92 % of all patients were satisfied with the result and wou ld accept the same treatment again. Radiologically, a clinical correlate co uld be found for the arrosions at the acromion and occasionally for the sec ondary upwards displacement of the humerus. The results correlated well wit h data from the literature. Conclusions: For posttraumatic conditions, hemi arthroplasty led to better results within four weeks and seemed to be a sui table alternative to other procedures, especially in older patients. Patien ts with primary osteoarthritis and idiopathic humeral head necrosis can exp ect good to excellent results after hemiarthroplasty. In both groups, the o verall results depend mainly upon patient compliance and the state of the r otator cuff.