JSES - 2026-05-01 - Journal Article; Comparative Study
Outcomes of pyrolytic carbon humeral resurfacing hemiarthroplasty compared to best-in-class total shoulder arthroplasty in young patients with osteoarthritis: analysis from the Australian Orthopaedic Association National Joint Replacement Registry.
McBride A, Hurley R, Gill D, Du P, Duke P, Taylor F, Hoy G, Page R, Ross M
Topics
Key Takeaway
Pyrocarbon humeral resurfacing hemiarthroplasty achieves 10-year cumulative revision rate of 7.7% versus 9.0% for best-in-class anatomic TSA in patients under 65, with no statistically significant difference in revision risk.
Summary Depth
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Summary
This registry study compared 10-year survivorship of pyrocarbon humeral resurfacing (PHR) versus the five best-performing anatomic TSA prosthesis combinations in patients under 65 with primary OA using Australian Orthopaedic Association National Joint Replacement Registry data. Cox proportional hazard models adjusted for age and sex showed no significant difference in revision risk between PHR (CPR 7.7%, 95% CI 4.7–12.4) and aTSA (CPR 9.0%, 95% CI 7.4–11.0). Dominant revision causes differed: implant breakage drove 35% of PHR revisions versus loosening driving 33.9% of aTSA revisions.
Key Limitation
The aTSA comparator was restricted to the five lowest-CPR prosthesis combinations, creating a best-case benchmark that may not reflect real-world aTSA performance, potentially underestimating the relative advantage of PHR.
Original Abstract
BACKGROUND
Pyrocarbon hemi-resurfacing and pyrocarbon hemi-arthroplasty is an emerging class of arthroplasty that demonstrates superior survivorship compared with metal hemiarthroplasty and resurfacing. However, it is unknown whether it is a superior option when compared to total shoulder arthroplasty in young patients. We compared the survivorship and reasons for revision between pyrocarbon resurfacing and the best-performing anatomic total shoulder arthroplasty prostheses from a large national arthroplasty registry.
METHODS
The study population included all primary shoulder arthroplasty procedures undertaken for osteoarthritis (OA) in patients aged <65 years and reported to the Registry between September 2004 and December 2022. The cumulative percentage revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models adjusted for age and sex. Two cohort groups were compared: pyrolytic carbon (pyrocarbon) humeral hemi-resurfacing (PHR) and 5 anatomic total shoulder replacement (aTSA) prosthesis combinations with the lowest CPR at 5 years, using polyethylene cemented glenoids and restricted to patients aged <65 years.
RESULTS
A total of 403 PHRs with a mean age of 52.5 years and 1,952 aTSAs with a mean age of 58.6 years were analyzed. Twenty PHRs (5.0%) and 123 aTSAs (6.3%) were revised, with a CPR at 10 years of 7.7% (95% confidence interval [CI] 4.7-12.4) and 9.0% (95% CI 7.4-11), respectively. The PHR and aTSA revision risk did not differ. The predominant reason for revision was implant breakage (35%) for PHR, compared with loosening (33.9%) for aTSA.
CONCLUSION
Pyrocarbon humeral resurfacing arthroplasty has a comparable survivorship in younger patients compared with best-in-class anatomic total shoulder arthroplasty.