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Background <p>Shoulder hemiarthroplasty (HA) is a well-established treatment for various humeral-side pathologies. Overstuffing should be avoided because it is associated with glenoid wear; however, specific radiological reconstruction targets remain unclear. This study assessed the association between radiological joint restoration in stemmed and stemless HA and long-term functional outcomes.</p> Methods <p>Patients who underwent stemmed or stemless HA between 2001 and 2011 were included in a long-term follow-up. Cases with incomplete or non-calibratable digital radiographs or concomitant glenoid procedures were excluded. Clinical outcomes were evaluated using the Constant-Murley Score (CMS) and satisfaction questionnaires. Radiographic parameters—lateral glenohumeral offset (LGHO), lateral humeral offset (LHO), and center of rotation (COR)—were measured on standardized anteroposterior radiographs pre- and postoperatively by two independent observers. Differences from baseline to final follow-up (ΔLHO, ΔLGHO, ΔCOR) were calculated. Interobserver reliability was determined using the intraclass correlation coefficient (ICC). Associations between radiological measures and clinical outcomes were analyzed using linear regression; intergroup comparisons used unpaired t-tests (<i>p</i> &lt; 0.05).</p> Results <p>Forty-eight patients (12 stemmed, 36 stemless HA) were examined after a mean follow-up of 16.6 ± 2.5 years. CMS did not differ between groups (stemmed 50.5 ± 20.8 vs. stemless 54.1 ± 20.4, <i>p</i> = 0.603). Complete radiographic data were available for 25 patients. Interobserver agreement was excellent for LHO (ICC = 0.93) and very good for LGHO (ICC = 0.85). Mean reconstruction values were close to zero for LHO (ΔLHO = − 0.3 ± 5.1&#xa0;mm), slightly underreconstructed for LGHO (ΔLGHO = − 6.3 ± 12.9&#xa0;mm), and slightly medialized for COR (ΔCOR = − 3.5 ± 8.5&#xa0;mm). Linear regression revealed a significant negative association between ΔLHO and CMS (R² = 0.45; coefficient = − 4.9; <i>p</i> = 0.02).</p> Conclusion <p>Both stemmed and stemless HA achieve satisfactory long-term outcomes after over 16 years. Accurate reconstruction of the lateral humeral offset correlates with improved functional results.</p>

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Offset reconstruction in stemless and stemmed shoulder hemiarthroplasty: influence on long-term outcomes

  • 期刊论文

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  • 发表日期：

    2026年6月3日

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  • Raphael Trefzer,
  • Amina Gurda,
  • Julian Deisenhofer,
  • Johannes Weishorn,
  • Mustafa Hariri,
  • Kevin-Arno Koch,
  • Matthias Wolf,
  • Matthias Bülhoff

摘要

Background

Shoulder hemiarthroplasty (HA) is a well-established treatment for various humeral-side pathologies. Overstuffing should be avoided because it is associated with glenoid wear; however, specific radiological reconstruction targets remain unclear. This study assessed the association between radiological joint restoration in stemmed and stemless HA and long-term functional outcomes.

Methods

Patients who underwent stemmed or stemless HA between 2001 and 2011 were included in a long-term follow-up. Cases with incomplete or non-calibratable digital radiographs or concomitant glenoid procedures were excluded. Clinical outcomes were evaluated using the Constant-Murley Score (CMS) and satisfaction questionnaires. Radiographic parameters—lateral glenohumeral offset (LGHO), lateral humeral offset (LHO), and center of rotation (COR)—were measured on standardized anteroposterior radiographs pre- and postoperatively by two independent observers. Differences from baseline to final follow-up (ΔLHO, ΔLGHO, ΔCOR) were calculated. Interobserver reliability was determined using the intraclass correlation coefficient (ICC). Associations between radiological measures and clinical outcomes were analyzed using linear regression; intergroup comparisons used unpaired t-tests (p < 0.05).

Results

Forty-eight patients (12 stemmed, 36 stemless HA) were examined after a mean follow-up of 16.6 ± 2.5 years. CMS did not differ between groups (stemmed 50.5 ± 20.8 vs. stemless 54.1 ± 20.4, p = 0.603). Complete radiographic data were available for 25 patients. Interobserver agreement was excellent for LHO (ICC = 0.93) and very good for LGHO (ICC = 0.85). Mean reconstruction values were close to zero for LHO (ΔLHO = − 0.3 ± 5.1 mm), slightly underreconstructed for LGHO (ΔLGHO = − 6.3 ± 12.9 mm), and slightly medialized for COR (ΔCOR = − 3.5 ± 8.5 mm). Linear regression revealed a significant negative association between ΔLHO and CMS (R² = 0.45; coefficient = − 4.9; p = 0.02).

Conclusion

Both stemmed and stemless HA achieve satisfactory long-term outcomes after over 16 years. Accurate reconstruction of the lateral humeral offset correlates with improved functional results.