Risk factors for failing to achieve improvement after anatomic total shoulder arthroplasty for glenohumeral osteoarthritis
Risk factors for failing to achieve improvement after anatomic total shoulder arthroplasty for glenohumeral osteoarthritis
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DOI：
10.1016/j.jse.2017.12.018
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发表时间：
2018-06-01
影响因子：
3
通讯作者：
Gulotta, Lawrence V.
中科院分区：
文献类型：
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作者：
Mahony, Gregory T.;Werner, Brian C.;Gulotta, Lawrence V.
背景：尽管解剖型全肩关节置换术（TSA）成功地改善了疼痛和功能，但并非所有患者的临床症状都得到改善。本研究旨在确定术后2年初次TSA治疗骨关节炎后未能改善的患者相关因素。方法：本前瞻性研究回顾了2007年至2013年接受初次TSA治疗骨关节炎的连续患者的机构肩关节登记，基线和术后2年美国肩肘外科医生（ASES）标准化肩关节评估表评分。失败结局定义为（1）未能达到ASES最小临床重要差异16.1分或（2）首次手术后2年内施行翻修术，或两者兼而有之。单变量和多变量分析的临床和人口患者因素进行了Logistic regression.Results：459关节置换术，符合纳入标准，411被认为是成功的上述标准，48（10.5%）未能达到理想的结果。与失败相关的临床风险因素包括既往肩关节手术（P = 0.047），肩袖撕裂（P = 0.025）和糖尿病（P = 0.036），调整年龄，性别，种族和体重指数后。术前ASES评分越高，手术失败率越高（P <0.001）。结论：既往肩关节手术史、TSA期间肩袖撕裂需要修复、糖尿病、非优势臂手术以及基线ASES评分越高，解剖型TSA后未能改善的风险越高。(C)2017肩肘外科杂志董事会。All rights reserved.
Background: Although anatomic total shoulder arthroplasty (TSA) successfully improves pain and function, not all patients improve clinically. This study was conducted to determine patient-related factors for failure to achieve improvement after primary TSA for osteoarthritis at 2 years postoperatively.Methods: This prospective study reviewed an institutional shoulder registry for consecutive patients who underwent primary TSA for osteoarthritis from 2007 to 2013 with baseline and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form scores. A failed outcome was defined as (1) a failure to reach the ASES minimal clinically important difference of 16.1 points or (2) revision surgery within 2 years of the index procedure, or both. Univariate and multivariable analyses of clinical and demographic patient factors were performed using logistic regression.Results: Of 459 arthroplasties that met inclusion criteria, 411 were deemed successful by the aforementioned criteria, and 48 (10.5%) failed to achieve a desirable outcome. Clinical risk factors associated with failure included previous surgery to the shoulder (P = .047), presence of a torn rotator cuff (P =.025), and presence of diabetes (P = .036), after adjusting for age, sex, race, and body mass index. A higher preoperative ASES score at baseline was associated with failure (P < .001).Conclusion: Previous shoulder surgery, a rotator cuff tear requiring repair during TSA, presence of diabetes, surgery on the nondominant arm, and a higher baseline ASES score were associated with a higher risk of failing to achieve improvement after anatomic TSA. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.