title: Surface replacement arthroplasty for glenohumeral arthropathy in patients aged younger than fifty years: results after a minimum ten-year follow-up.
abstract: BACKGROUND
  The role of cementless surface replacement arthroplasty (CSRA) in young individuals is currently unclear. The aim of this study was to evaluate CSRA long-term results for glenohumeral arthritis in young patients.
  
  
  METHODS
  Between 1990 and 2003, 54 CSRAs were performed on 49 patients (25 men, 24 women) aged younger than 50 years. Mean age was 38.9 years (range, 22-50 years). Three patients (4 shoulders) died over time and 8 were lost to follow-up, leaving 38 patients (42 shoulders) with a mean follow-up of 14.5 years (range, 10-25 years). There were 17 total shoulder replacements with metal back glenoid, and 37 underwent humeral head resurfacing with microfracture of the glenoid.
  
  
  RESULTS
  The indications were avascular necrosis, 16; rheumatoid arthritis, 20; instability arthropathy, 7; primary osteoarthritis, 5; fracture sequelae, 3; postinfection arthritis, 2; and psoriatic arthritis, 1. The mean relative Constant score increased from 11.5% to 71.8% (P < .0001), and the mean patient satisfaction at final follow-up was 8.7 of 10. The mean relative Constant score for the humeral head resurfacing with microfracture of the glenoid improved to 77.7% compared with 58.1% for total resurfacing arthroplasty. Two required early arthrodesis due to instability and deep infection. Seven were revised to stemmed prosthesis: 1 for traumatic fracture and 1 for glenoid erosion 16 years after the index procedure. Five shoulders in 4 patients (4 rheumatoid arthritis, 1 avascular necrosis) were revised at 8 to 14 years after surgery for cuff failure and loosening. Three were revised to stemless reverse total shoulder arthroplasty due to rotator cuff failure at 23, 16, and 13 years after surgery.
  
  
  CONCLUSIONS
  CSRA provides good long-term symptomatic and functional results in the treatment of glenohumeral arthropathy in patients aged younger than 50 years in 81.6% of the patients. This improvement is maintained over more than 10 years after surgery, with high patient satisfaction (8.7 of 10). However, 10 shoulders (of 54) (18.5%) underwent revision arthroplasty. Resurfacing offers a valuable tool in treating young patients with glenohumeral arthritis, providing reasonably good long-term results in 81.6% of the patients, while allowing preservation of bone stock if the need for revision arises. All the revision arthroplasty options are preserved, including less invasive procedures.
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK. Electronic address: oferlevy@readingshoulderunit.com.
authors.forename: Ofer
authors.initials: O
authors.lastname: Levy
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK.
authors.forename: Oren
authors.initials: O
authors.lastname: Tsvieli
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Merchant
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK.
authors.forename: Lora
authors.initials: L
authors.lastname: Young
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK.
authors.forename: Alberto
authors.initials: A
authors.lastname: Trimarchi
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK.
authors.forename: Rupen
authors.initials: R
authors.lastname: Dattani
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK.
authors.forename: Ruben
authors.initials: R
authors.lastname: Abraham
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Copeland
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Narvani
authors.affiliation: Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, Berkshire, UK.
authors.forename: Ehud
authors.initials: E
authors.lastname: Atoun
mesh_terms: D000328:Adult; D001168:Arthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D019643:Arthroplasty, Replacement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012540:Scapula / Q000000981:diagnostic imaging / Q000601:surgery; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Arthroplasty; cementless; hydroxyapatite; resurfacing; shoulder; surface replacement; young