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End-stage glenohumeral osteoarthritis
1%
40/2991
Glenoid wear to the level of the coracoid
21%
636/2991
Non-retracted isolated supraspinatus tear
10%
313/2991
Patient’s age
63%
1898/2991
Presence of subchondral cysts
2%
62/2991
Select Answer to see Preferred Response
Anatomic total shoulder arthroplasty (TSA) is an effective treatment for patients with glenohumeral arthritis. However, the presence of insufficient glenoid bone stock (wear to the level of the coracoid) would favor the use of a hemiarthroplasty. Success of a TSA depends on the proper functioning of the soft tissues (intact and functional rotator cuff muscles). Rotator cuff arthropathy and irreparable cuff tears are contraindications to a TSA; however, the presence of a reparable rotator cuff tear is not. End-stage glenohumeral arthritis will show evidence of glenoid wear (i.e. subchondral cysts), but the presence of inadequate glenoid bone stock (wear to the level of the coracoid) is also a contraindication to TSA use. While concerns regarding glenoid component loosening with the use of a TSA in younger active patients has been reported, recent studies have favored its use to that of hemiarthroplasty in this aged cohort. Sperling et al. reviewed the use of hemiarthroplasty and TSA in patients aged 50 years and younger. They reported better results with TSA and noted a 20-year survival rate for TSA and hemiarthroplasty to be 84% and 75%, respectively. They concluded that there is a moderate rate of hemiarthroplasty revision for painful glenoid arthritis and TSA may be a reasonable treatment option in this aged cohort. Dillon et al. reviewed the results of 2,981 patients treated with arthroplasty. Despite an increased risk of revision in younger patients, they found those treated with TSA had better outcomes and a lower risk of revision compared with those treated with hemiarthroplasty or reverse TSA. They concluded that patients 59 years and younger have a higher risk of revision for those treated with hemiarthroplasty, supporting the use of total shoulder arthroplasty in this aged cohort. Bartelt et al. reviewed the outcomes and survival rates of TSA with those of hemiarthroplasty in patients under the age of 55 years. They found a statistically significant improvement in pain, an increase in active elevation, and higher patient satisfaction in the patients undergoing TSA. They noted a 10-year survival rate for TSA and hemiarthroplasty of 92% and 77%, respectively. They concluded that TSA provides favorable in terms of pain relief, motion, and implant survival compared with hemiarthroplasty. Illustration A is a depiction of the various types of shoulder arthroplasty Incorrect Answers: Answer 1: The presence of end-stage glenohumeral osteoarthritis is an indication for use of both TSA and hemiarthroplasty Answer 3: A non-retracted isolated supraspinatus tear is amendable to repair at the time of TSA implementation. It is not a contraindication to TSA use Answer 4: Recent literature has supported the use of TSA over hemiarthroplasty in patients under the age of 55 years demonstrating better outcomes, implant survival, and satisfaction Answer 5: Presence of subchondral cysts is a common finding with end-stage glenohumeral arthritis and supports use of both TSA and hemiarthroplasty
2.1
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