RSA, TSA and PyC hemi-prostheses: comparing indications and clinical outcomes using a second-generation modular short-stem shoulder prosthesis.

Abstract

INTRODUCTION:

The goal of this study was to provide an insight into the clinical results after modular short-stem shoulder arthroplasty for various indications.

MATERIALS AND METHODS:

A consecutive cohort study of 76 patients followed up for 23-55 (mean 31.4) months. 23 anatomical (TSA), 32 reverse (RSA) and 21 hemi-prostheses with a pyrocarbon head (PyC), using a modular short stem with proximal porous coating were implanted. Range of motion, pain and Constant score (CS) were recorded. Comparisons of pre- vs postoperative outcomes, between prosthesis types and indications, were made.

RESULTS:

All prosthesis types brought about a significant improvement (p < 0.05) in all measured outcomes. TSA had a significantly higher increase in the CS than PyC and RSA (p = 0.002 and 0.003, respectively). TSA produced superior gains in all ROM compared with RSA (p < 0.02). RSA brought about significantly smaller improvements in internal rotation than TSA and PyC (p = 0.0001 and 0.008, respectively). TSA had greater pain relief than PyC (p = 0.02). TSA with Walch A glenoids seemed to improve more than type B in the CS. PyC patients with Walch B glenoids improved more than Walch A (p = 0.03). When implanted due to Osteoarthritis (OA), PyC had a comparable final outcome to TSA (p = 0.95), although the preoperatively worse TSA patients had a greater improvement in the CS (p = 0.026). The outcome of RSA did not differ between indications, but Walch A glenoids tended to improve more.

CONCLUSIONS:

Using a second-generation short-stem shoulder prostheses, TSA achieves the best clinical improvements overall, especially for OA with a Walch A glenoid. Despite refixation of the subscapularis tendon in all cases, RSA has inferior internal rotation than TSA and PyC, suggesting a mechanical limitation. OA, a Walch B glenoid and arthritis caused by instability seem to be ideal indications when considering PyC.

• Authors: Benjamin D Kleim, Christina Garving, Ulrich H Brunner
• Journal: Archives of orthopaedic and trauma surgery (Arch Orthop Trauma Surg) Vol. 141 Issue 10 Pg. 1639-1648 (Oct 2021) ISSN: 1434-3916 [Electronic] Germany
• PMID: 33025070 (Publication Type: Journal Article)
• Copyright: © 2020. The Author(s).

Chemical References

• pyrolytic carbon
• Carbon

Topics

• Arthroplasty, Replacement, Shoulder
• Carbon
• Cohort Studies
• Humans
• Range of Motion, Articular
• Retrospective Studies
• Shoulder Joint (surgery)
• Shoulder Prosthesis
• Treatment Outcome