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Upper Limb: J. F. Haines, I. A. Trail, D. Nuttall, A. Birch, and A. Barrow The results of arthroplasty in osteoarthritis of the shoulder J Bone Joint Surg Br 2006; 88-B: 496-501 [Abstract] [Full text] [PDF]

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The results of arthroplasty in osteoarthritis of the shoulder

Quamar Bismil, Majid Chowdhry, David M Ricketts   (5 June 2006)

The results of arthroplasty in osteoarthritis of the shoulder 5 June 2006
Quamar Bismil, specialist registrar orthopaedics and trauma Princess Royal Hospital, Haywards Heath, Majid Chowdhry, David M Ricketts Send letter to journal: Re: The results of arthroplasty in osteoarthritis of the shoulder quamar.bismil{at}btinternet.com Quamar Bismil, et al.	Sir, In this paper the authors report good results for shoulder arthoplasty in patients with osteoarthritis. We would like to make the following points: 1. Similar results have been reported using the Copeland resurfacing hemiarthroplasty. Levy and Copeland1 reported good results in 89.9% of patients when using this prosthesis as a hemiarthroplasty in osteoarthritis. It avoids complications related to the use of a glenoid component and humeral stem. 2. We note the association demonstrated between superior migration of the humeral head and size of preoperative cuff tear. The literature shows that tears increase in size with time.2 Progression of a tear would influence the results. Were the smaller tears noted in the current study monitored for progression? Also, the tears noted in the study were diagnosed clinically at operation. Preoperative ultrasound would have increased the detection rate of partial thickness and smaller tears. 3. The study included interfering variables. Despite the title of the study, 29 of the 124 patients had avascular necrosis and post-traumatic arthritis. These patients had poor results. Management of the glenoid also varied regarding the indication for glenoid resurfacing, the use of metal backing and the use of pegs or a keel for glenoid fixation. These latter factors were not fully discussed in the results and may have influenced the rate of glenoid loosening. Q.Bismil, SpR Orthopaedics and Trauma, M. Chowdhry, SHO Orthopaedics and Trauma, D.M. Ricketts, Consultant Orthopaedic Surgeon, The Princess Royal Hospital, Haywards Heath, West Sussex, UK. 1. Levy O, Copeland SA. Cementless surface replacement arthroplasty (Copeland CSRA) for osteoarthritis of the shoulder. J Shoulder Elbow Surg 2004;13:266-71. 2. Yamaguchi K, Tetro AM, Blam O, et al. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg 2001;10:199-203.