Outcome of Revision Shoulder Arthroplasty After Resurfacing Hemiarthroplasty in Patients with Glenohumeral Osteoarthritis
Bibliographic record
Abstract
BACKGROUND: Patients are often treated with a resurfacing hemiarthroplasty in the expectation that the bone-preserving design facilitates revision should the need for a revision arthroplasty arise. The aim of this study was to report the outcome of patients with glenohumeral osteoarthritis who underwent revision shoulder arthroplasty after resurfacing hemiarthroplasty. METHODS: We reviewed all patients with osteoarthritis reported to the Danish Shoulder Arthroplasty Registry from 2006 to 2013. There were 1,210 primary resurfacing hemiarthroplasties, of which 107 cases (9%) required a revision surgical procedure, defined as the removal or exchange of the humeral component or the addition of a glenoid component. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate outcome at 1 year. RESULTS: The median WOOS of revision arthroplasty after failed resurfacing hemiarthroplasty was 62 points (interquartile range, 40 to 88 points). Of the 80 cases that had follow-up, 33 (41%) had an unacceptable outcome, defined as a WOOS of ≤50 points. Of the 107 cases that required a revision surgical procedure, 11 arthroplasties (10%) required a further revision surgical procedure. The resurfacing hemiarthroplasty was revised to a stemmed hemiarthroplasty (n = 39), anatomic total shoulder arthroplasty (n = 31), or reverse shoulder arthroplasty (n = 30). In 7 cases, the revision arthroplasty design was unknown. The median WOOS of patients who underwent revision stemmed hemiarthroplasty (48 points) was significantly inferior (p = 0.002) to that of patients who underwent primary stemmed hemiarthroplasty (75 points); the median WOOS of patients who underwent revision anatomic total shoulder arthroplasty (74 points) was also significantly inferior (p = 0.007) to that of patients who underwent primary anatomic total shoulder arthroplasty (93 points). However, the median WOOS of patients who underwent revision reverse shoulder arthroplasty (68 points) was not significantly different (p = 0.66) from that of patients who underwent primary reverse shoulder arthroplasty (77 points) used in the treatment of osteoarthritis. CONCLUSIONS: The outcome of revision shoulder arthroplasty after failed resurfacing hemiarthroplasty was variable and, in many cases, disappointing. It is important that resurfacing hemiarthroplasty is used for the correct indications and with adequate technique and skill. When resurfacing hemiarthroplasty is used in the treatment of osteoarthritis, revision cannot be counted upon as a fallback. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".