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2014 ; 472
(11
): 3510-6
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High incidence of hemiarthroplasty for shoulder osteoarthritis among recently
graduated orthopaedic surgeons
#MMPMID25146057
Mann T
; Baumhauer JF
; O'Keefe RJ
; Harrast J
; Hurwitz SR
; Voloshin I
Clin Orthop Relat Res
2014[Nov]; 472
(11
): 3510-6
PMID25146057
show ga
BACKGROUND: Primary glenohumeral osteoarthritis is a common indication for
shoulder arthroplasty. Historically, both total shoulder arthroplasty (TSA) and
hemi-shoulder arthroplasty (HSA) have been used to treat primary glenohumeral
osteoarthritis. The choice between procedures is a topic of debate, with HSA
proponents arguing that it is less invasive, faster, less expensive, and
technically less demanding, with quality of life outcomes equivalent to those of
TSA. More recent evidence suggests TSA is superior in terms of pain relief,
function, ROM, strength, and patient satisfaction. We therefore investigated the
practice of recently graduated orthopaedic surgeons pertaining to the surgical
treatment of this disease. QUESTIONS/PURPOSES: We hypothesized that (1) recently
graduated, board eligible, orthopaedic surgeons with fellowship training in
shoulder surgery are more likely to perform TSA than surgeons without this
training; (2) younger patients are more likely to receive HSA than TSA; (3)
patient sex affects the choice of surgery; (4) US geographic region affects
practice patterns; and (5) complication rates for HSA and TSA are not different.
METHODS: We queried the American Board of Orthopaedic Surgery's database to
identify practice patterns of orthopaedic surgeons taking their board
examination. We identified 771 patients with primary glenohumeral osteoarthritis
treated with TSA or HSA from 2006 to 2011. The rates of TSA and HSA were compared
based on the treating surgeon's fellowship training, patient age and sex, US
geographic region, and reported surgical complications. RESULTS: Surgeons with
fellowship training in shoulder surgery were more likely (86% versus 72%; OR
2.32; 95% CI, 1.56-3.45, p<0.001) than surgeons without this training to perform
TSA rather than HSA. The mean age for patients receiving HSA was not different
from that for patients receiving TSA (66 versus 68, years, p=0.057). Men were
more likely to receive HSA than TSA when compared to women (RR 1.54; 95% CI,
1.19-2.00, p=0.0012). The proportions of TSA and HSA were similar regardless of
US geographic region (Midwest HSA 21%, TSA 79%; Northeast HSA 25%, TSA 75%;
Northwest HSA 16%, TSA 84%; South HSA 27%, TSA 73%; Southeast HSA 24%, TSA 76%;
Southwest HSA 23%, TSA 77%; overall p=0.708). The overall complication rates were
not different with the numbers available: 8.4% (15/179) for HSA and 8.1% (48/592)
for TSA (p=0.7555). CONCLUSIONS: The findings of this study are at odds with the
recommendations in the current clinical practice guidelines for the treatment of
glenohumeral osteoarthritis published by the American Academy of Orthopaedic
Surgeons. These guidelines favor using TSA over HSA in the treatment of shoulder
arthritis. Further investigation is needed to clarify if these practice patterns
are isolated to recently graduated board eligible orthopaedic surgeons or if the
use of HSA continues with orthopaedic surgeons applying for recertification.
LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for
a complete description of levels of evidence.
|Aged
[MESH]
|Evidence-Based Practice
[MESH]
|Fellowships and Scholarships/statistics & numerical data
[MESH]
|Female
[MESH]
|Hemiarthroplasty/psychology/*statistics & numerical data
[MESH]