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Abstract：
BACKGROUND: Bilateral reverse shoulder arthroplasty (RSA) is controversial because of potential rotational deficits impairing daily living activities. We assessed achievement of insufficient internal rotation (IR) and associated factors in bilateral RSA patients.
METHODS: Fifty-seven staged bilateral RSA patients with a minimum of 1 year of follow-up after the second intervention were identified from our local monocentric register. Shoulder range of motion (including IR using the Apley scratch test), strength, and Constant and Shoulder Pain and Disability Index scores were assessed preoperatively and 6, 12, and 24 months postoperatively.
RESULTS: Before surgery, both shoulders were similar regarding imaging parameters, but first operated shoulders tended to have poorer function. One year after the first RSA, 21% of patients had insufficient IR (not reaching the lumbosacral junction) compared with 33% after the second intervention (P = .180). At 2 years, 5% of patients had insufficient IR on both sides. Patients with insufficient IR on the second side at baseline (relative risk [RR], 1.8 [1.0-3.2]) and patients with insufficient IR 1 year after the first RSA (RR, 3.0 [1.6-5.6]) were more likely to have insufficient IR 1 year after the second RSA. Constant and Shoulder Pain and Disability Index scores and abduction of the second side were significantly worse 1 year after the second RSA (P ≤ .047); at 2 years, there were no differences in functional outcome between shoulders.
CONCLUSIONS: A minority of bilateral RSA patients did not achieve sufficient IR on at least 1 side. Staged surgery is justified, particularly when the outcome of the initial operation is satisfactory.
METHODS: Fifty-seven staged bilateral RSA patients with a minimum of 1 year of follow-up after the second intervention were identified from our local monocentric register. Shoulder range of motion (including IR using the Apley scratch test), strength, and Constant and Shoulder Pain and Disability Index scores were assessed preoperatively and 6, 12, and 24 months postoperatively.
RESULTS: Before surgery, both shoulders were similar regarding imaging parameters, but first operated shoulders tended to have poorer function. One year after the first RSA, 21% of patients had insufficient IR (not reaching the lumbosacral junction) compared with 33% after the second intervention (P = .180). At 2 years, 5% of patients had insufficient IR on both sides. Patients with insufficient IR on the second side at baseline (relative risk [RR], 1.8 [1.0-3.2]) and patients with insufficient IR 1 year after the first RSA (RR, 3.0 [1.6-5.6]) were more likely to have insufficient IR 1 year after the second RSA. Constant and Shoulder Pain and Disability Index scores and abduction of the second side were significantly worse 1 year after the second RSA (P ≤ .047); at 2 years, there were no differences in functional outcome between shoulders.
CONCLUSIONS: A minority of bilateral RSA patients did not achieve sufficient IR on at least 1 side. Staged surgery is justified, particularly when the outcome of the initial operation is satisfactory.
摘要：
背景：双侧反向肩关节置换术（RSA）存在争议，因为潜在的旋转缺陷会损害日常生活活动。我们评估了双侧RSA患者内旋不足（IR）的成就和相关因素。
方法：从我们当地的单中心记录中确定了57例分期的双侧RSA患者，在第二次干预后至少随访1年。肩关节运动范围(包括采用Apley划痕试验的IR),力量,术前和术后6、12和24个月评估恒定和肩痛和残疾指数评分。
结果：手术前，两肩在成像参数上相似，但是第一次手术的肩膀往往功能较差。第一次RSA发布一年后，21％的患者IR不足（未到达腰s部），而第二次干预后为33％（P=.180）。在2年,5%的患者存在两侧IR不足。基线时第二侧IR不足的患者（相对风险[RR]，1.8[1.0-3.2]）和首次RSA后1年IR不足的患者（RR，3.0[1.6-5.6]）在第二次RSA后1年更有可能IR不足。在第二次RSA后1年，恒定和肩痛和残疾指数评分和第二侧外展显著恶化(P≤.047)；在2年，两肩之间的功能结局没有差异.
结论：少数双侧RSA患者至少一侧未达到足够的IR。分期手术是合理的，特别是当最初手术的结果令人满意时。
方法：从我们当地的单中心记录中确定了57例分期的双侧RSA患者，在第二次干预后至少随访1年。肩关节运动范围(包括采用Apley划痕试验的IR),力量,术前和术后6、12和24个月评估恒定和肩痛和残疾指数评分。
结果：手术前，两肩在成像参数上相似，但是第一次手术的肩膀往往功能较差。第一次RSA发布一年后，21％的患者IR不足（未到达腰s部），而第二次干预后为33％（P=.180）。在2年,5%的患者存在两侧IR不足。基线时第二侧IR不足的患者（相对风险[RR]，1.8[1.0-3.2]）和首次RSA后1年IR不足的患者（RR，3.0[1.6-5.6]）在第二次RSA后1年更有可能IR不足。在第二次RSA后1年，恒定和肩痛和残疾指数评分和第二侧外展显著恶化(P≤.047)；在2年，两肩之间的功能结局没有差异.
结论：少数双侧RSA患者至少一侧未达到足够的IR。分期手术是合理的，特别是当最初手术的结果令人满意时。
