Hemi- versus bipolar shoulder arthroplasty for chronic rotator cuff arthropathy

Both bipolar and hemiarthroplasty have been used to treat rotator cuff arthropathy (RCA) of the shoulder in patients with low functional demands. In this study, 41 patients treated with either a bipolar or hemiarthroplasty were selected retrospectively to detect possible differences in the functional outcome and to evaluate radiological properties of the implants. Patients were examined before and 30 ± 6 months after surgery. There were no differences in the Constant scores between the groups treated with hemiarthroplasty and bipolar arthroplasty, 58.9 ± 13.1 points and 55.8 ± 13.5 points, respectively (P = 0.457). We found a significant increase in abduction postoperatively in both groups (P = 0.041 bipolar, P = 0.000 hemiarthroplasty) but without statistical significance between the hemiarthroplasty and bipolar arthroplasty groups (P = 0.124, F = 2.6). This result is related in the bipolar group due to movement between the shell and inner head (P = 0.042) and in the hemiarthroplasty group due to movement between the humeral head component and the glenoid (P = 0.000). In conclusion, we found that both hemiarthroplasty and bipolar arthroplasty are effective treatment options for carefully selected patients with RCA and low functional demands, with no differences between the groups

A symptom-based classification for shoulders with massive rotator cuff defects

The aim of this prospective study was to propose a classification for shoulders with massive rotator cuff defects based on patients’ clinical symptoms. A total of 100 shoulders with massive rotator cuff tears were evaluated clinically using the Constant score (CS) and with radiographs in two planes. Three types were defined and correlated with radiographic findings: (1) the arthritic type (type I), (2) the non-reactive type (type II) and (3) the necrotic type (type III). Significant differences in the overall CS (type I: 28.6 points, range: 4 – 61; type II: 18.8 points, range: 6 – 52; type III: 15.5 points, range: 6 – 31) and its subgroups and in shoulder motion were found between types I and II and between types I and III (p < 0.05). This classification may be helpful for the decision-making process with regard to the appropriate form of shoulder replacement surgery in patients with massive rotator cuff defects

Complications in shoulder arthroplasty: an analysis of 485 cases

The aim of this study was to analyse the complication rates of six different shoulder arthroplasty concepts for different diagnoses in the short and midterm. The study included 485 primary shoulder arthroplasties. The mean follow-up of the cohort was 3.5 (1–10) years. Complications were classified into three categories: (1) without reoperation, (2) soft tissue revision and (3) implant revision. In total, 56 complications were recorded (11.6%): 34 (7%) were category 1 complications, 11 (2.3%) were category 2 and 11 (2.3%) were category 3. For the whole cohort the median follow-up was 1.6 years (1–10 years) and the survival rate without any complication was 90.5% (95% CI: 87.9–93.1). Patients rated the result of their surgery in 270 (55.7%) cases as very satisfied, in 148 (30.5%) as satisfied, in 43 (8.9%) as somewhat disappointed and in 24 (4.9%) as disappointed. A relatively low complication rate was found in this study. Long-term observations are necessary to confirm these results