PDF(Pubmed)
Abstract：
Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are used in the management of osteoarthritis of the glenohumeral joint. We aimed to determine whether TSA or HA resulted in a lower risk of adverse outcomes in patients of all ages with osteoarthritis and an intact rotator cuff and in a subgroup of patients aged 60 years or younger.
Shoulder arthroplasties recorded in the National Joint Registry, UK, between April 1, 2012 and June 30, 2021, were linked to Hospital Episode Statistics in England. Elective TSAs and HAs were matched on propensity scores based on 11 variables. The primary outcome was all-cause revision. Secondary outcomes were combined revision/non-revision reoperations, 30-day inpatient complications, 1-year mortality, and length of stay. 95% confidence intervals (CI) were reported.
11,556 shoulder arthroplasties were included: 7,641 TSAs, 3,915 HAs. At 8 years 95% (CI 94-96) of TSAs and 91% (CI 90-92) of HAs remained unrevised. The hazard ratio (HR) varied across follow-up: 4-year HR 2.7 (CI 1.9-3.5), 8-year HR 2.0 (CI 0.5-3.5). Rotator cuff insufficiency was the most common revision indication. In patients aged 60 years or younger prosthesis survival at 8 years was 92% (CI 89-94) following TSA and 84% (CI 80-87) following HA.
The risk of revision was higher following HA in patients with osteoarthritis and an intact rotator cuff. Patients aged 60 years and younger had a higher risk of revision following HA.
Shoulder arthroplasties recorded in the National Joint Registry, UK, between April 1, 2012 and June 30, 2021, were linked to Hospital Episode Statistics in England. Elective TSAs and HAs were matched on propensity scores based on 11 variables. The primary outcome was all-cause revision. Secondary outcomes were combined revision/non-revision reoperations, 30-day inpatient complications, 1-year mortality, and length of stay. 95% confidence intervals (CI) were reported.
11,556 shoulder arthroplasties were included: 7,641 TSAs, 3,915 HAs. At 8 years 95% (CI 94-96) of TSAs and 91% (CI 90-92) of HAs remained unrevised. The hazard ratio (HR) varied across follow-up: 4-year HR 2.7 (CI 1.9-3.5), 8-year HR 2.0 (CI 0.5-3.5). Rotator cuff insufficiency was the most common revision indication. In patients aged 60 years or younger prosthesis survival at 8 years was 92% (CI 89-94) following TSA and 84% (CI 80-87) following HA.
The risk of revision was higher following HA in patients with osteoarthritis and an intact rotator cuff. Patients aged 60 years and younger had a higher risk of revision following HA.
摘要：
目的：全肩关节置换术（TSA）和半肩关节置换术（HA）用于治疗肱骨关节的骨关节炎。我们的目的是确定TSA或HA是否导致所有年龄的骨关节炎和完整肩袖患者以及60岁或以下患者亚组的不良结局风险较低。
方法：国家关节注册记录的肩关节置换术，英国,2012年4月1日至2021年6月30日，与英格兰的医院事件统计有关。选择的TSA和HAs在基于11个变量的倾向得分上进行匹配。主要结果是全因修正。次要结果是合并修订/非修订再次手术，30天住院并发症,1年死亡率，和逗留时间的长短。报告95%置信区间(CI)。
结果：包括11,556例肩关节置换术：7,641个TSA，3915HAs。在8年时，95%(CI94-96)的TSA和91%(CI90-92)的HAs仍未修订。风险比(HR)在随访期间有所不同：4年HR2.7(CI1.9-3.5)，8年HR2.0（CI0.5-3.5）。肩袖功能不全是最常见的翻修适应症。在60岁或更年轻的患者中，TSA后8年的假体生存率为92％（CI89-94），HA后为84％（CI80-87）。
结论：对于骨性关节炎和完整的肩袖患者，HA后翻修的风险更高。60岁及以下的患者在HA后有更高的翻修风险。
方法：国家关节注册记录的肩关节置换术，英国,2012年4月1日至2021年6月30日，与英格兰的医院事件统计有关。选择的TSA和HAs在基于11个变量的倾向得分上进行匹配。主要结果是全因修正。次要结果是合并修订/非修订再次手术，30天住院并发症,1年死亡率，和逗留时间的长短。报告95%置信区间(CI)。
结果：包括11,556例肩关节置换术：7,641个TSA，3915HAs。在8年时，95%(CI94-96)的TSA和91%(CI90-92)的HAs仍未修订。风险比(HR)在随访期间有所不同：4年HR2.7(CI1.9-3.5)，8年HR2.0（CI0.5-3.5）。肩袖功能不全是最常见的翻修适应症。在60岁或更年轻的患者中，TSA后8年的假体生存率为92％（CI89-94），HA后为84％（CI80-87）。
结论：对于骨性关节炎和完整的肩袖患者，HA后翻修的风险更高。60岁及以下的患者在HA后有更高的翻修风险。
