Background: A systematic review of the literature was performed to
estimate the impact of hemiarthroplasty compared with total shoulder
arthroplasty on function and range of motion in patients suffering from
osteoarthritis of the shoulder.
Methods: We conducted an electronic search for relevant studies
published in any language from 1966 to 2004, a manual search of the
proceedings from five major orthopaedic meetings from 1995 to 2003, and a
review of the reference lists from potentially relevant studies. Four
randomized clinical trials, with similar eligibility criteria and surgical
techniques, that compared hemiarthroplasty and total shoulder arthroplasty for
the treatment of primary osteoarthritis of the shoulder were found to be
eligible. Authors from three of the four studies provided original patient
data. Analysis of covariance focused on the two-year outcome and included a
comparison of the aggregate University of California at Los Angeles shoulder
score, four University of California at Los Angeles domain scores, and range
of motion.
Results: A total of 112 patients (fifty managed with
hemiarthroplasty and sixty-two managed with total shoulder arthroplasty), who
had a mean age of sixty-eight years, were included in this analysis. A
significant moderate effect was detected in the function domain of the
University of California at Los Angeles shoulder score (p < 0.001) in favor
of total shoulder arthroplasty (mean [and standard deviation], 8.1 ±
0.3) compared with hemiarthroplasty (mean, 6.6 ± 0.3). A significant
difference in the pain score was found in favor of the total shoulder
arthroplasty group (p < 0.0001). However, the large degree of heterogeneity
(p = 0.006, I2 = 80.2%) among the studies decreased our confidence
that total shoulder arthroplasty provides a true, consistent benefit with
regard to pain. There was a significant difference in the overall change in
forward elevation of 13° (95% confidence interval, 0.5° to 26°) in
favor of the total shoulder arthroplasty group (p = 0.008).
Conclusions: At a minimum of two years of follow-up, total shoulder
arthroplasty provided better functional outcome than hemiarthroplasty for
patients with osteoarthritis of the shoulder. Since continuous degeneration of
the glenoid after hemiarthroplasty or glenoid loosening after total shoulder
arthroplasty may affect the eventual outcome, longer-term (five to ten-year)
results are necessary to determine whether these findings remain consistent
over time.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.