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Pyrocarbon interposition shoulder arthroplasty in advanced collapse of the humeral head

Interpositions-Hemiprothese aus Pyrocarbon bei fortgeschrittener Humeruskopfnekrose

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Abstract

Background

Pyrocarbon (PyC) interposition shoulder arthroplasty can be used to treat advanced collapse of the humeral head after avascular necrosis.

Objectives

We examined outcomes for this bone-preserving implant which has a PyC coating and a novel biomechanical concept.

Materials and methods

For a minimum of 2 years, we followed 10 patients (4 men, 6 women, 55.6 ± 12.9 years) treated with a free interposition PyC arthroplasty (“snookerball”) due to advanced humeral head collapse but with an intact glenoid and rotator cuff. Anteroposterior radiographs, the Constant score (CS), adjusted CS, DASH score, and the EuroQol 5D–5L score from the preoperative and the latest follow-up presentation were compared.

Results

At a mean of 3.6 years (±15 months), the mean absolute CS was 70.6 (±13.6; adjusted CS 81.4 ± 16.4), the DASH score was 25.6 (±16.1), the mean EQ subjective VAS score was 72.6 (±15.9), and the EQ index score was 0.9 (±0.11). Scores improved: CS: +63.2 ± 12.9; adjusted CS: +72.9 ± 15.5; DASH: +47.2 ± 14.7; EQ VAS: +42.6 ± 16.8; EQ index score +0.52 ± 0.23. Mean glenoid erosion was 1.4 mm (±1.3 mm), thinning of the tuberosities was −0.8 mm (±3.3 mm), and superior migration of the implant was 2.0 mm (±2.2). A thin radiolucent zone around the implant with bone densification on the metaphyseal side was observed in all cases (mean 1.8 ± 0.6 mm).

Conclusions

Excellent improvement of function and quality of life which are comparable to total shoulder arthroplasty data were observed. Significant bone remodeling occurs in the metaphysis around the implant. Further studies are needed to evaluate longevity and applicability of the implant. These results indicate that advanced collapse of the humeral head with an intact glenoid and rotator cuff are an optimal indication for this implant.

Zusammenfassung

Hintergrund

Eine Interpositions-Hemiprothese aus Pyrocarbon (PyC) ist eine Option zur Behandlung der ausgeprägten avaskulären Humeruskopfnekrose.

Fragestellung

Die Ergebnisse dieses knochensparenden Implantats mit neuartiger Biomechanik wurden ermittelt.

Material und Methoden

Zehn Patienten (4 m., 6 w., Alter: 55,6 ± 12,9 Jahre) wurden wegen fortgeschrittener Humeruskopfnekrose mit pyrocarbonbeschichteter Interpositions-Hemiprothese („Snookerball“) behandelt und mindestens 2 Jahre postoperativ beobachtet. Glenoid und Rotatorenmanschette waren intakt. a.-p.-Röntgenbilder, Constant Score (CS), angepasster CS, DASH und EuroQol 5D–5 L (EQ) aus präoperativer und aktuellster Kontrolluntersuchung wurden verglichen.

Ergebnisse

Nach durchschnittlich 3,6 Jahren (±15 Monate) postoperativ lag der absolute CS im Durchschnitt bei 70,6 (±13,6), der angepasste CS bei 81,4 (±16,4). Der DASH lag bei 25,6 (±16,1), der EQ VAS bei 72,6 (±15,9) und der EQ-Index bei 0,9 (±0,11). Die Werte verbesserten sich: CS: +63,2 ± 12,9; angepasster CS: +72,9 ± 15,5; DASH: +47,2 ± 14,7; EQ VAS: +42,6 ± 16,8; EQ-Index: +0,52 ± 0,23. Die Glenoiderosion erreichte im Durchschnitt 1,4 mm (±1,3 mm), die knöcherne Substanz der Tubercula verschmälerte sich um −0,8 mm (±3,3 mm), und das Implantat verschob sich um 2,0 mm (±2,2) nach kranial. Eine schmale, röntgentransparente Zone mit metaphysärem Sklerosierungssaum bildete sich bei allen rund um das Implantat aus (1,8 mm, ±0,6 mm).

Schlussfolgerung

Funktion und Lebensqualität verbesserten sich ausgezeichnet und waren vergleichbar mit den Ergebnissen nach Totalendoprothese. Knöcherne Umbauprozesse traten in der Metaphyse rund um das Implantat auf. Weitere Studien sind nötig, um die Langlebigkeit und Anwendbarkeit des Implantats zu ermitteln. Den bisherigen Ergebnissen zufolge ist die fortgeschrittene Humeruskopfnekrose bei erhaltenem Glenoid und intakter Rotatorenmanschette eine optimale Indikation für das neuartige Implantat.

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Abbreviations

AP:

Anteroposterior

AVN:

Avascular humeral head necrosis

CS:

Constant score

DASH:

Disabilities of Arm, Shoulder, and Hand

EQ:

EuroQol EQ 5D–5L

FU:

Follow-up

HA:

Hemiarthroplasty

LOA:

Limits of agreement

MALDI-TOF:

Matrix-assisted laser desorption/ionization time of flight

MRI:

Magnetic resonance imaging

PyC:

Pyrocarbon

ROM:

Range of motion

SD:

Standard deviation

TSA:

Total shoulder arthroplasty

VAS:

Visual analog scale

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Authors and Affiliations

  1. Klinik für Schulter- und Ellbogenchirurgie, RHÖN Klinikum AG, Salzburger Leite 1, 97616, Bad Neustadt, Germany

    R. Hudek MD, B. Werner, A. F. Abdelkawi & F. Gohlke

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  1. R. Hudek MD
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  2. B. Werner
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  3. A. F. Abdelkawi
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  4. F. Gohlke
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Correspondence to R. Hudek MD.

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Conflict of interest

R. Hudek, B. Werner, A. Abdelkawi and F. Gohlke declare that they have no competing interests.

Ethical committee approval: Given by the Freiburger Ethik-Kommission, Feki Code: 014/1483. Written consent was given by each patient prior to surgery. The manuscript has been read and approved by all authors, and all authors believe that the manuscript presents honest work.

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Hudek, R., Werner, B., Abdelkawi, A. et al. Pyrocarbon interposition shoulder arthroplasty in advanced collapse of the humeral head. Orthopäde 46, 1034–1044 (2017). https://doi.org/10.1007/s00132-017-3495-2

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