Shoulder arthroplasty in patients with osteo-chondrodysplasias

Abstract

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.

Keywords: Custom implant; Dysplasia; Osteo-chondrodysplasia; Short stature; Shoulder arthoplasty; Skeletal dysplasia.