HTA - Sahlgrenska Universitetssjukhuset

Total shoulder arthroplasty versus hemiarthroplasty (PICO2)
The systematic literature search identified two randomised controlled trials (RCT),
and five non-randomised controlled studies, in which TSA have been compared to
HA in patients with primary glenohumeral osteoarthritis. Both RCTs were of
moderate quality, and were the same two trials also included in the Cochrane review
of 2010. One of the non-randomised controlled studies was of moderate and the
remaining four studies were of low quality.
Overall shoulder score
Two RCTs and five non-randomised controlled studies compared TSA with HA,
Appendix 1:1.
Conclusion: There were no differences between the study groups at end of follow-up.
Low quality of evidence (GRADE ⊕⊕��), Appendix 4.
Pain
Two RCTs and five non-randomised controlled studies compared TSA with HA,
Appendix 1:2, Appendix 4.
Conclusion: There were no differences between the study groups at end of follow-up.
Low quality of evidence (GRADE ⊕⊕��), Appendix 4.
Quality of Life
One RCT and one non-randomised controlled study compared TSA with HA,
Appendix 1:3.
Conclusion: There were no differences between the study groups at end of follow-up.
Low quality of evidence (GRADE ⊕⊕��), Appendix 4.
Mobility
Two RCTs and three non-randomised controlled studies compared TSA with HA,
Appendix 1:4, Appendix 4.
Conclusion: There were no differences between the study groups at end of follow-up.
Low quality of evidence (GRADE ⊕⊕��), Appendix 4.
Activity of daily life
One RCT and four non-randomised controlled studies compared TSA with HA,
Appendix 1:5.
Conclusion: There were no differences between the study groups at end of follow-up.
Very low quality of evidence (GRADE ⊕���), Appendix 4.
Surgical revision
Two RCTs and two non-randomised controlled studies compared TSA with HA,
Appendix 1:6.
Conclusion: The number of surgical revisions was very low, which made comparisons
between the two arthroplasties not meaningful.
Very low quality of evidence (GRADE ⊕���), Appendix 4.
Complications
Complications can be divided into early complications that occur within three weeks
after surgery, or late complications that occur after three weeks. Most of the studies
have only reported the overall rate of complications that could be directly related to
surgery. Thus, the rate of “any complication” presented in Appendix 1-7 will be
identical with that of the rate of “complications directly related to surgery” for most
studies.
13(17)