Shoulder arthroplasty in patients with osteo-chondrodysplasias

Purpose

Osteo-chondrodysplasias are a rare cause of limb malalignment, deformity and degenerative joint disease. Earlier in life, deformities may be managed with bony realignment and soft tissue releases; however, as degenerative changes progress, arthroplasty may be considered. There are limited reports examining shoulder arthroplasty in this population. This study aims to assess pain relief, function, and re-operation rate of shoulder arthroplasty in patients with osteo-chondrodysplasias.

Methods

Between January 1984 and December 2012, 13 shoulders with end-stage arthritis secondary to osteo-chondrodysplasia underwent shoulder arthroplasty. Three were treated with hemiarthroplasty (HA), nine with anatomic total shoulder arthroplasty (TSA), and one with a reverse total shoulder arthroplasty (RSA). All shoulders were followed for two years or until reoperation (mean 7.9 years, range 2–25).

Results

Shoulder arthroplasty significantly improved pain, elevation, external rotation, and internal rotation. All but one patient considered their shoulder to be better than pre-operatively; however, only two shoulders received an excellent Neer rating. Seven shoulders had satisfactory Neer ratings and four unsatisfactory. One TSA was converted to a RSA for aseptic glenoid loosening at 9.5 years (re-operation rate 8%).

Discussion

Pain relief and improved function can be expected in patients with osteo-chondrodysplasias despite challenging anatomy. Unlike the only previous case series reporting a 31% revision rate at mean follow-up of seven years, our series shows the incidence of failure to be much lower.

Conclusions

With the advent of smaller humeral components, the need for custom implants may not be necessary, and surgeons may intervene earlier and more confidently in this population.

Level of evidence: IV case series