Article

Although shoulder hemiarthroplasty (SHA) can improve function in
osteoarthritic shoulders, the ability to perform activities of daily living (ADL)
may remain impaired. Shoulder surgeons routinely measure parameters such as range
of motion, pain, satisfaction and strength. A common subjective assessment of ADL
is part of the Constant Score (CS). However, there is limited objective evidence
on whether or not shoulder hemiarthroplasty can restore normal range of motion
(ROM) in ADL. METHODS: The study included eight consecutive patients (n=8; seven
women, one man), who underwent SHA for glenohumeral osteoarthritis. The patients
were examined the day before, as well as 6 months and 3 years after shoulder
replacement. They were compared with a control group with no shoulder pathology,
and shoulder movement was measured with 3D motion analysis using the "Heidelberg
Upper Extremity" (HUX) model. Measurements included static maximum values and
four ADL. RESULTS: Comparing the preoperative to the 3-year postoperative static
maximum values, there were significant improvements for abduction from 50.5
degrees (SD +/- 3 2.4 degrees ) to 72.4 degrees (SD +/- 38.2 degrees ; p=0.031),
for adduction from 6.2 degrees (SD +/- 7.7 degrees ) to 66.7 degrees (SD +/- 18.0
degrees ; p=0.008), for external rotation from 15.1 degrees (SD +/- 27.9 degrees
) to 50.9 degrees (SD +/- 27.3 degrees ; p=0.031), and for internal rotation from
-0.6 degrees (SD +/- 3.9 degrees ) to 35.8 degrees (SD +/- 28.2 degrees ;
p=0.031). There was a trend of improvement for flexion from 105.8 degrees (SD +/-
45.7 degrees ) to 161.9 degrees (SD +/- 78.2 degrees ; p=0.094) and for extension
from 20.6 degrees (SD +/- 17.0 degrees ) to 28.0 degrees (SD +/- 12.5 degrees ;
p=0.313). The comparison of the 3-year postoperative ROM between the SHA group
and controls showed significant differences in abduction; 3-year postoperative
SHA ROM 72.4 degrees (SD +/- 38.2 degrees ) vs. 113.5 degrees (SD +/- 29.7
degrees ) among controls (p=0.029). There were no significant differences
compared to the control group in adduction, flexion/extension and rotation 3
years after SHA surgery. In performing the ADL, the pre- to the 6-month and
3-year postoperative status of the SHA group resulted in a significant increase
in ROM in all planes (p<0.05). Comparing the preoperative to the 3-year
postoperative ROM used in ADL, there was an improvement in the flexion/extension
plane, showing an improvement trend from preoperative 85 degrees -0 degrees -25
degrees to postoperative 127 degrees -0 degrees -38 degrees (p=0.063). In
comparison, controls used a significantly greater ROM during ADL with mean
flexion/extension of 139 degrees -0 degrees -63 degrees (p=0.028). For the
abduction/adduction plane, ROM improved significantly from preoperative 25
degrees -0 degrees -19 degrees to postoperative 78 degrees -0 degrees -60 degrees
(p=0.031). In comparison to controls with abduction/adduction of 118 degrees -0
degrees -37 degrees 3 years postoperative, the SHA group also used significantly
less ROM in the abduction/adduction plane (p=0.028). CONCLUSION: While SHA
improves ROM in ADL in patients with degenerative glenohumeral osteoarthritis, it
does not restore the full ROM available for performing ADL compared to controls.
3D motion analysis with the HUX model is an appropriate measurement system to
detect surgery-related changes in shoulder arthroplasty.
CI - Copyright (c) 2013 Elsevier B.V. All rights reserved.

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