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Durability of Partial Humeral Head Resurfacing

Ruth A. Delaney M.D.¹, Michael T. Freehill M.D.^1,2, Laurence D. Higgins M.D.², Jon J.P. Warner M.D.¹

^{Harvard Shoulder Service, 1Massachusetts General Hospital, 2Brigham & Women’s Hospital, Boston, MA, 02114}

Partial humeral head resurfacing arthroplasty utilizes a stemless device, which conserves bone and restores normal anatomy. We hypothesized that this does not offer a reasonable alternative to full resurfacing or total shoulder arthroplasty.

This is a retrospective study of 39 shoulders with focal chondral defects of the humeral head treated with partial resurfacing arthroplasty. Minimum 2-year follow-up is reported, unless failure and operative intervention superceded this duration. Mean follow-up was 51.3 months. Mean age was 45.6 years (range 27–76). Pre and post-operative evaluation included history,physical examination,radiographs, and clinical scoring using ASES Shoulder Score Index(SSI) and Subjective Shoulder Value(SSV).

Twenty-five of 39 shoulders (64.1%) demonstrated functional improvement and decreased pain. Significant mean improvements were observed in forward flexion (121.3o to 151.6o;p = 0.002), external rotation(37.1o to 58.3o;p=0.0003), mean SSV(30.75% to 73.6%;p < 0.0001),and ASES score (29.35 to 70;p <0.0001). However, at an average of 26.6 months follow up, the failure group included 6 patients (15.3%) who underwent revision and another four (10.2%) who were recommended revision. Patients with no prior or concomitant procedure were rare (n=5) but had the most reliable outcomes with partial resurfacing, with no failures in that group. Of the 24 patients with prior procedures, 5 had been revised, and the clinical outcome scores for the remaining patients were consistently lower than those seen in patients without prior procedures.

Concomitant pathology and prior or concomitant surgical procedures potentially impair the outcome of the resurfacing procedure and could be a contraindication. Long-term success remains guarded with this treatment modality, especially in patients whose chondral injury is not an isolated finding.