SHOULDER HEMIARTHROPLASTY AT KNH
:CLINICAL AND RADIOLOGICAL OUTCOME AT ONE
YEAR
DR DAVID G.KINYANJUI
ORTHOPAEDIC SURGEON
KNH
INTRODUCTION
 The earliest recorded shoulder arthroplasty was in 1893 by pean
where he used platinum and rubber to manage TB arthritis
Others were:

1921:Albee used proximal fibula to replace lost proximal
humerus
 1933:Jones rounded off proximal humerus
 1950:Neer humeral head prosthesis(hemiarthroplasty)
 1974:Neer 2 humeral head prosthesis
 1980’s:numerous modular humeral components
 1990’s:Anatomical prosthesis
 Currently shoulder replacement is in form hemiarthroplasty and
total replacement.
INTRODUCTION(cont)
• Lesions of the shoulder which require
arthroplasty are much fewer as compared to
hip and knee.
• Shoulder arthropasty at knh is a rare surgery
mainly due to unavailability of implants .
• Have been performed only during the annual
orthopaedic projects.
CLASSIFICATION
1.TOTAL SHOULDER ARTHROPLASTY
 unconstrained
 semiconstrained
 constrained(ball and socket/reverse ball
and socket)
2.HEMIARTHROPLASTY
TOTAL SHOULDER ARTHROPLASTY VERSUS
HEMIARTHROPLASTY
• Results of total shoulder arthroplasty are
similar to hemiarthroplasty when glenoid is
minimally affected(farmer et al)
• Hemiarthroplasty had fewer complications
and hospital stay shorter
• In glenoid involvement total shoulder
replacement had better results.
Study objectives
Broad objective
• To assess the patients out come at 1 year
Specific objectives
a. To assess overall pain relief,range of motion,
ease of doing daily activities and patient
satisfaction at one year.
b. To assess complications at one year
Study methodology
• A retrospective audit
• Project files obtained from records
• Some from my clinical records
RESULTS
• From 2010 to 2015 a total of 16 patients
underwent shoulder hemiarthropasty at knh
• 6 patients underwent hemiarthroplasty in
august 2015 and hence were not yet one
year(not eligible)
• 1 patients was lost to follow up at one year
• 9 patients were considered
• A total of 9 patients considered
• 7 female and 3 male
• All with osteoarthritis
PATIENTS CHARACTERISTICS
•
•
•
•
•
•
•
•
•
Age:60-92 years
Gender:female 7 and male 2
Diagnosis :All had osteoarthritis
Symptoms:
(a)pain:All
(b) shoulder stiffness:All
Radiologial features:
(a)osteoarthritis with concentric glenoid:7
(b)osteoarthritis with glenoid erosion:2
CASE 1
POST-OPERATIVE
PRE-OPERATIVE
CASE 2
preoperative
Post operative
CASE 3
PREOPERATIVE
POSTOPERATIVE
CASE 4
PREOPERATIVE
POSTOPERATIVE
CASE5
PREOPERATIVE
POSTOPERATIVE
CASE6
PREOPERATIVE
POSTOPERATIVE
RESULTS
• Clinical outcomes
(a)pain
(b)Motion
(c)Ease of doing daily activities
(c)satisfaction
• Radiological complications
(a)loosening of implants
(b)glenoid erosion
(c)subluxation
(d)dislocation
CLINICAL RESULTS
PAIN
RLIEF
%
RANGE OF
MOTION
%
IMPROVED
DAILY
ACTIVITIES
%
EXCELLENT
4
44.5%
0
0%
0
0%
GOOD
2
22.2%
3
33.3%
5
55.6%
SAME AS
BEFORE
2
22.2%
5
55.6%
3
33.3%
WORSE
1
1.1%
1
1.1%
1
1.1%
SATISFACTION
NUMBER
PERCENT
SATISFIED
6
66.7%
NOT SATISFIED
3
33.3%
COMPLICATIONS
NUMBER
PERCENTAGE
COMPONENT
LOOSENING
1
11.1%
PERIPROSTHETIC
FRACTURE
2
22.2%
GLENOID EROSION
1
11.1%
DISLOCATION
0
0%
SUBLUXATION
1
11.1%
COMPLICATION:SUBLUXATION
COMPLICATION:PERIPROSTHETIC
FRACTURE WITH VARUS
COMPLICATION:PERIPROSTHETIC
FRACTURE
IMMEDIATE POSTOPERATIVE
1YEAR- PERIPROSTHETIC
FRACTURE
COMPLICATION:GLENOID EROSION
AND COMPONENT LOOSENING
DISCUSSION
Shoulder hemiarthroplasty is an alternative to
total shoulder replacement in selected
patients
Despite a small sample the results at one year
are promising.
As more are done a clearer picture will
emerge on clinical outcomes
 Further follow-up needed to establish long
term outcomes
THANK YOU