Five-Year Radiographic and Clinical Outcomes of Pyrocarbon Hemiarthroplasty for Glenohumeral Arthritis and Osteonecrosis.

Abstract

This study evaluated the progression of humeral head medialization in patients who underwent pyrocarbon hemiarthroplasty (PyC-HA). The authors hypothesized that glenoid erosion would not dramatically progress between the short-term and final imaging evaluations, and that there would be excellent clinical outcomes at ≥5-year follow-up. Patients who underwent PyC-HA with ≥60 months of follow-up were included in this prospective study. Relevant data included preoperative demographic characteristics, Walch glenoid classification, changes in clinical outcomes, and revision-free and failure-free survival rates. An investigator, who was blinded to patient outcomes, assessed the glenoid morphology, changes in medialization, joint space, acromiohumeral distance (AHD), critical shoulder and β angles, and posterior subluxation in decentered glenoids at the 2-year and final follow-up visits. Forty-five patients with a mean age of 52 years and a mean follow-up of 73 months met the inclusion criteria. Significant improvements were observed across all outcome measures. The 7-year revision-free survival rate was 95.7%. Posterior subluxation in decentered shoulders decreased from 27.1% preoperatively to 19.8% postoperatively (p = 0.008). The mean medialization of the humeral head was 2.9 ± 2.8 mm at the 2-year follow-up and increased to 4.0 ± 3.3 mm at the time of the final follow-up (p = 0.096). A >2-mm decrease in AHD from early postoperative to final imaging was observed in 82.2% of patients (p < 0.001). All other radiographic changes were not significant. PyC-HA is a reliable procedure for treating glenohumeral joint disease, demonstrating excellent clinical outcomes and stabilized glenoid morphology in the majority of patients between the 2-year and intermediate-term follow-up. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.