Abstract：
BACKGROUND: Reverse total shoulder arthroplasty (rTSA) has begun to challenge the place of anatomic total shoulder arthroplasty (aTSA) as a primary procedure for certain indications. One purported benefit of aTSA is improved postoperative range of motion (ROM) compared to rTSA especially in internal rotation; however, it is unclear whether aTSA can provide patients with significant preoperative stiffness superior ROM compared to rTSA. Our purpose was to compare clinical outcomes of aTSA and rTSA performed in stiff vs. non-stiff shoulders for rotator cuff intact (RCI) glenohumeral osteoarthritis (GHOA).
METHODS: A retrospective review of an international shoulder arthroplasty database identified 1608 aTSAs and 600 rTSAs performed for RCI GHOA with minimum 2-year follow-up. Defining preoperative stiffness as ≤ 0° of passive external rotation (ER), we matched: (1) stiff aTSAs (n = 257) 1:3 to non-stiff aTSAs, (2) stiff rTSAs (n = 87) 1:3 to non-stiff rTSAs, and (3) stiff rTSAs (n = 87) 1:1 to stiff aTSAs. We compared ROM, outcome scores, and the rate of complications and revision surgery at latest follow-up.
RESULTS: Despite stiff aTSAs having poorer preoperative ROM and functional outcome scores for all measures assessed (P < .001 for all), only poorer postoperative active abduction (113 ± 27° vs. 128 ± 35°; P < .001), active ER (39 ± 18° vs. 50 ± 20°; P < .001), and passive ER (45 ± 17° vs. 56 ± 18°; P < .001) persisted postoperatively compared to the non-stiff cohort. Similarly, stiff rTSAs had poorer preoperative ROM and functional outcome scores for all measures assessed compared to non-stiff rTSAs (P ≤ .044), but only poorer active abduction (108 ± 24° vs. 128 ± 29°, P < .001), active ER (28 ± 17° vs. 42 ± 17°, P < .001), and passive ER (36 ± 15° vs. 48 ± 17°, P < .001) persisted. When comparing stiff rTSAs to matched stiff aTSAs, no significant differences in preoperative ROM or functional outcome scores were found. However, stiff aTSAs had greater postoperative active internal rotation score (4.8 ± 1.5 vs. 4.2 ± 1.7, P = .022), active ER (40 ± 19° vs. 28 ± 17°, P < .001), and passive ER (46 ± 18° vs. 36 ± 15°, P = .001). Postoperative outcome scores were similar across all matched cohort comparisons despite motion differences. The rate of complications and need for revision surgery did not differ between any group comparisons.
CONCLUSIONS: Patients with RCI GHOA who have preoperative rotational stiffness have poorer postoperative ROM compared with non-stiff patients following both aTSA and rTSA, but similar functional outcome scores. Notably, preoperative limitations in passive ER do not appear to be a limitation to utilizing aTSA. Indeed, patients with limited preoperative ER treated with aTSA had greater postoperative internal rotation and ER compared to those treated with rTSA.
METHODS: A retrospective review of an international shoulder arthroplasty database identified 1608 aTSAs and 600 rTSAs performed for RCI GHOA with minimum 2-year follow-up. Defining preoperative stiffness as ≤ 0° of passive external rotation (ER), we matched: (1) stiff aTSAs (n = 257) 1:3 to non-stiff aTSAs, (2) stiff rTSAs (n = 87) 1:3 to non-stiff rTSAs, and (3) stiff rTSAs (n = 87) 1:1 to stiff aTSAs. We compared ROM, outcome scores, and the rate of complications and revision surgery at latest follow-up.
RESULTS: Despite stiff aTSAs having poorer preoperative ROM and functional outcome scores for all measures assessed (P < .001 for all), only poorer postoperative active abduction (113 ± 27° vs. 128 ± 35°; P < .001), active ER (39 ± 18° vs. 50 ± 20°; P < .001), and passive ER (45 ± 17° vs. 56 ± 18°; P < .001) persisted postoperatively compared to the non-stiff cohort. Similarly, stiff rTSAs had poorer preoperative ROM and functional outcome scores for all measures assessed compared to non-stiff rTSAs (P ≤ .044), but only poorer active abduction (108 ± 24° vs. 128 ± 29°, P < .001), active ER (28 ± 17° vs. 42 ± 17°, P < .001), and passive ER (36 ± 15° vs. 48 ± 17°, P < .001) persisted. When comparing stiff rTSAs to matched stiff aTSAs, no significant differences in preoperative ROM or functional outcome scores were found. However, stiff aTSAs had greater postoperative active internal rotation score (4.8 ± 1.5 vs. 4.2 ± 1.7, P = .022), active ER (40 ± 19° vs. 28 ± 17°, P < .001), and passive ER (46 ± 18° vs. 36 ± 15°, P = .001). Postoperative outcome scores were similar across all matched cohort comparisons despite motion differences. The rate of complications and need for revision surgery did not differ between any group comparisons.
CONCLUSIONS: Patients with RCI GHOA who have preoperative rotational stiffness have poorer postoperative ROM compared with non-stiff patients following both aTSA and rTSA, but similar functional outcome scores. Notably, preoperative limitations in passive ER do not appear to be a limitation to utilizing aTSA. Indeed, patients with limited preoperative ER treated with aTSA had greater postoperative internal rotation and ER compared to those treated with rTSA.
摘要：
背景：反向全肩关节成形术（rTSA）已经开始挑战解剖全肩关节成形术（aTSA）作为某些适应症的主要手术的位置。与rTSA相比，aTSA的一个所谓的好处是改善了术后运动范围（ROM），尤其是在内部旋转中；但是，与rTSA相比,aTSA能否为患者提供显著的术前僵硬度优于ROM,目前尚不清楚.我们的目的是比较aTSA和rTSA在僵硬和非僵硬的肩关节完整（RCI）肱骨关节炎（GHOA）中的临床结果。
方法：一项对国际肩关节置换术数据库的回顾性审查确定了1,608个aTSA和600个rTSA用于RCIGHOA，至少随访2年。术前刚度定义为被动ER≤0°，我们匹配：（1）刚性aTSA（n=257）1：3与非刚性aTSA，（2）刚性rTSA（n=87）1：3与非刚性rTSA，和(3)刚性rTSA(n=87)1:1与刚性aTSA。我们比较了ROM,结果分数，以及最新随访时的并发症发生率和翻修手术率。
结果：尽管僵硬的aTSA在所有评估指标中具有较差的术前ROM和功能结局评分（全部P<0.001），仅较差的术后主动外展（113±27°vs.128±35°,P<0.001)，有效ER(39±18°vs.50±20°,P<0.001)，和被动ER(45±17°vs.56±18°,P<0.001）与非僵硬队列相比，术后持续存在。同样，与非僵硬rTSAs相比，僵硬rTSAs的术前ROM和功能结局评分较差（P≤0.044），但只有较差的活动外展（108±24°与128±29°,P<0.001)，有效ER(28±17°vs.42±17°,P<0.001)，和被动ER(36±15°vs.48±17°,P<0.001）持续存在。将刚性rTSA与匹配的刚性aTSA进行比较时，术前ROM或功能结局评分无显著差异.然而,僵硬的aTSAs术后活动性IR评分更高（4.8±1.5vs.4.2±1.7,P=0.022),有效ER(40±19°vs.28±17°,P<0.001)，和被动ER(46±18°vs.36±15°,P=0.001)。尽管运动差异，但所有匹配队列比较的术后结果评分相似。在任何组比较中，并发症的发生率和翻修手术的需要没有差异。
结论：术前有旋转僵硬的RCIGHOA患者在aTSA和rTSA后的术后ROM与非僵硬患者相比更差，但功能结果得分相似。值得注意的是,被动ER的术前限制似乎不是使用aTSA的限制。的确,与接受rTSA治疗的患者相比,接受aTSA治疗的术前ER受限患者术后内旋和外旋更大.
方法：一项对国际肩关节置换术数据库的回顾性审查确定了1,608个aTSA和600个rTSA用于RCIGHOA，至少随访2年。术前刚度定义为被动ER≤0°，我们匹配：（1）刚性aTSA（n=257）1：3与非刚性aTSA，（2）刚性rTSA（n=87）1：3与非刚性rTSA，和(3)刚性rTSA(n=87)1:1与刚性aTSA。我们比较了ROM,结果分数，以及最新随访时的并发症发生率和翻修手术率。
结果：尽管僵硬的aTSA在所有评估指标中具有较差的术前ROM和功能结局评分（全部P<0.001），仅较差的术后主动外展（113±27°vs.128±35°,P<0.001)，有效ER(39±18°vs.50±20°,P<0.001)，和被动ER(45±17°vs.56±18°,P<0.001）与非僵硬队列相比，术后持续存在。同样，与非僵硬rTSAs相比，僵硬rTSAs的术前ROM和功能结局评分较差（P≤0.044），但只有较差的活动外展（108±24°与128±29°,P<0.001)，有效ER(28±17°vs.42±17°,P<0.001)，和被动ER(36±15°vs.48±17°,P<0.001）持续存在。将刚性rTSA与匹配的刚性aTSA进行比较时，术前ROM或功能结局评分无显著差异.然而,僵硬的aTSAs术后活动性IR评分更高（4.8±1.5vs.4.2±1.7,P=0.022),有效ER(40±19°vs.28±17°,P<0.001)，和被动ER(46±18°vs.36±15°,P=0.001)。尽管运动差异，但所有匹配队列比较的术后结果评分相似。在任何组比较中，并发症的发生率和翻修手术的需要没有差异。
结论：术前有旋转僵硬的RCIGHOA患者在aTSA和rTSA后的术后ROM与非僵硬患者相比更差，但功能结果得分相似。值得注意的是,被动ER的术前限制似乎不是使用aTSA的限制。的确,与接受rTSA治疗的患者相比,接受aTSA治疗的术前ER受限患者术后内旋和外旋更大.
