No difference in 10-year survivorship of total shoulder arthroplasty vs. hemiarthroplasty for avascular necrosis of the humeral head.

Autor: Parel PM; Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: pmparel2018@gwmail.gwu.edu., Lin S; Department of Orthopaedic Surgery, Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL, USA., Agarwal AR; Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Haft M; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Kreulen RT; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Naeem A; Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA., Pressman Z; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Best MJ; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Zimmer ZR; Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA., Srikumaran U; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jazyk: angličtina
Zdroj: Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2024 Nov; Vol. 33 (11), pp. 2352-2358. Date of Electronic Publication: 2024 May 11.
DOI: 10.1016/j.jse.2024.03.046
Abstrakt: Background: Avascular necrosis (AVN) of the humeral head is characterized by osteonecrosis secondary to disrupted blood flow to the glenohumeral joint. Following collapse of the humeral head, arthroplasty, namely, total shoulder arthroplasty (TSA) or humeral head arthroplasty (hemiarthroplasty), is recommended standard of care. The literature is limited to underpowered and small sample sizes in comparing arthroplasty modalities. Therefore, the aims of this study were (1) to compare the 10-year survivorship of TSA and hemiarthroplasty in the treatment of AVN of the humeral head and (2) to identify differences in their revision etiologies.
Methods: Patients who underwent primary TSA and hemiarthroplasty for AVN were identified using the PearlDiver database. TSA patients were matched by age, gender, and Charlson Comorbidity Index (CCI) to the hemiarthroplasty cohort in a 4:1 ratio because TSA patients were generally older, sicker, and more often female. The 10-year cumulative incidence rate of all-cause revision was determined using Kaplan-Meier survival analysis. Multivariable analysis was conducted using Cox proportional hazard modeling. χ 2 analysis was conducted to compare the indications for revisions between matched cohorts including periprosthetic joint infection (PJI), dislocation, mechanical loosening, broken implants, periprosthetic fracture, and stiffness.
Results: In total, 4825 patients undergoing TSA and 1969 patients undergoing hemiarthroplasty for AVN were included in this study. The unmatched 10-year cumulative incidence of revision for patients who underwent TSA and hemiarthroplasty was 7.0% and 7.7%, respectively. The matched 10-year cumulative incidence of revision for patients who underwent TSA and hemiarthroplasty was 6.7% and 8.0%, respectively. When comparing the unmatched cohorts, TSA patients were at significantly higher risk of 10-year all-cause revision (HR: 1.39; P = .017) when compared to hemiarthroplasty patients. After matching, there was no significant difference in risk of 10-year all-cause revision (HR: 1.29; P = .148) and no difference in the observed etiologies for revision (P > .05 for all).
Conclusion: After controlling for confounders, only 6.7% of TSA and 8.0% hemiarthroplasties for humeral head AVN were revised within 10 years of index surgery. The demonstrated high and comparable long-term survivorship for both modalities supports the utilization of either for the AVN induced humeral head collapse.
(Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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