Complications of shoulder arthroplasty for osteoarthritis with posterior glenoid wear
Complications of shoulder arthroplasty for osteoarthritis with posterior glenoid wear
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DOI：
10.1016/j.otsr.2014.06.002
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发表时间：
2014-09-01
影响因子：
2.3
通讯作者：
Farron, A.
中科院分区：
文献类型：
--
作者：
Gallusser, N.;Farron, A.
背景资料：解剖型全肩关节置换术（TSA）治疗盂肱骨关节炎（OA）和严重的后部关节盂磨损可能会导致早期术后并发症（后部半脱位复发、关节盂松动）。为了避免这些力学问题，最近提出了反向肩关节成形术（RSA），主要是为了其内在的稳定性。我们的目的是提出的结果TSA和RSA的盂肱关节OA与后方关节盂磨损至少20 degrees.Hypothesis：凭借其限制设计，RSA可以防止复发的后方半脱位和限制发生的机械并发症。材料和方法：一个连续系列的23例患者（27例肩关节）使用全肩关节假体治疗盂肱OA：19例TSA和8例RSA。平均年龄为70岁（范围，47-85岁），平均后倾角为28度（20度-50度），平均半脱位指数为74%（57-89%）。结果：TSA和RSA患者Constant评分分别为65和65分，主观肩关节评分分别为79%和74%，QuickDASH评分分别为16和27分，SST评分分别为88和78分。两名患者进行了手术翻修TSA，因为关节盂松动; 52%的TSA患者表现出完全的放射线和11%的复发后半luxation.Conclusion：并发症后，经常观察到关节盂严重后倾关节置换术OA。对于选定的患者，RSA可能是TSA的替代方案，与肩袖状态无关。现在需要对RSA在这一特定适应症中的研究进行更长时间的随访。证据等级：IV级;回顾性病例系列。(C)2014年Elsevier Masson SAS。All rights reserved.
Background: Anatomical total shoulder arthroplasty (TSA) for glenohumeral osteoarthritis (OA) and severe posterior glenoid wear may entail early postoperative complications (recurrence of posterior subluxation, glenoid loosening). To avoid these mechanical problems, reverse shoulder arthroplasty (RSA) has recently been proposed, mainly for its intrinsic stability. Our purpose was to present the results of TSA and RSA in glenohumeral OA with posterior glenoid wear of at least 20 degrees.Hypothesis: By virtue of its constrained design, RSA could prevent recurrence of posterior subluxation and limit the occurrence of mechanical complications.Materials and methods: A consecutive series of 23 patients (27 shoulders) were treated for glenohumeral OA with total shoulder prostheses: 19 TSAs and 8 RSAs. Mean age was 70 years (range, 47-85 years), mean retroversion angle 28 degrees (20 degrees-50 degrees) and mean subluxation index 74% (57-89%). Constant Score, Subjective Shoulder Value (SSV), QuickDASH and Simple Shoulder Test (SST) were measured, and radiological examinations were performed at a mean follow-up of 52 months (24-95 months).Results: TSA and RSA patients respectively displayed Constant Scores of 65 and 65, SSV of 79% and 74%, QuickDASH of 16 and 27, and SST of 88 and 78. Two patients underwent surgical revision of TSA because of glenoid loosening; 52% of TSA patients presented complete radiolucent lines and 11% recurrence of posterior subluxation.Conclusion: Complications are frequently observed after shoulder arthroplasty for OA with severe glenoid retroversion. RSA could be an alternative to TSA for selected patients, independently of rotator cuff status. Studies on RSA in this specific indication with longer follow-up are now needed.Level of evidence: Level IV; retrospective case series. (C) 2014 Elsevier Masson SAS. All rights reserved.