PDF(Pubmed)
Abstract：
UNASSIGNED: Improvements in pain control after shoulder arthroplasty with a reduction in narcotic use continues to be an important postoperative goal. With the increased utilization of stemless anatomic total shoulder arthroplasty (aTSA), it is relevant to compare between stemmed and stemless arthroplasty to assess if there is any association between this implant design change and early postoperative pain.
UNASSIGNED: Patients from a multicenter, prospectively-maintained database who had undergone a stemless aTSA with a minimum of two year clinical follow-up were retrospectively identified. Patients who underwent aTSA with a short stem were identified in the same registry, and matched to the stemless aTSA patients by age, sex and preoperative pain score. The primary study outcome was the Visual Analog Scale pain score. Secondary pain outcomes were the American Shoulder and Elbow Surgeons shoulder pain subscore, Western Ontario Osteoarthritis of the Shoulder physical symptoms subscore, and the Single Assessment Numeric Evaluation score. Finally, the percentage of patients who could sleep on the affected shoulder was assessed for each group. These pain-related clinical outcomes were assessed and compared preoperatively, and postoperatively at 9 weeks, 26 weeks, one year and two years. For all statistical comparisons, P > .05 was considered significant.
UNASSIGNED: 124 patients were included in the study; 62 in each group. At 9 weeks after surgery, statistically significantly improved pain control was reported by patients undergoing stemless aTSA, as assessed by the Visual Analog Scale (stemless: 1.5, stemmed: 2.5, P = .001), American Shoulder and Elbow Surgeons pain subscore (stemless: 42.4, stemmed: 37.3, P < .001), Western Ontario Osteoarthritis of the Shoulder Physical Symptoms (stemless: 80.3, stemmed: 73.1, P = .006) and Single Assessment Numeric Evaluation (stemless: 58.1, stemmed: 47.4, P = .011). Patients who underwent a stemless aTSA were significantly more likely to be able to sleep on the affected shoulder at 9 weeks (29% vs. 11%, odds ratio 3.2, 95% confidence interval 1.2-8.4, P = .014). By 26 weeks postoperatively, there were no differences in all pain-specific outcomes. At two years postoperatively, patient-reported outcomes, range of motion, and strength measures were all similar between the two cohorts.
UNASSIGNED: Stemless aTSA provides earlier improvement in postoperative shoulder pain compared to matched patients undergoing short-stem aTSA. Additionally, earlier return to sleeping on the affected shoulder was reported in the stemless aTSA group. The majority of these differences dissipate by 26 weeks postoperatively and there were no differences in pain, patient-reported outcomes, range of motion or strength measures between stemless and short-stem aTSA at 2 years postoperatively.
UNASSIGNED: Patients from a multicenter, prospectively-maintained database who had undergone a stemless aTSA with a minimum of two year clinical follow-up were retrospectively identified. Patients who underwent aTSA with a short stem were identified in the same registry, and matched to the stemless aTSA patients by age, sex and preoperative pain score. The primary study outcome was the Visual Analog Scale pain score. Secondary pain outcomes were the American Shoulder and Elbow Surgeons shoulder pain subscore, Western Ontario Osteoarthritis of the Shoulder physical symptoms subscore, and the Single Assessment Numeric Evaluation score. Finally, the percentage of patients who could sleep on the affected shoulder was assessed for each group. These pain-related clinical outcomes were assessed and compared preoperatively, and postoperatively at 9 weeks, 26 weeks, one year and two years. For all statistical comparisons, P > .05 was considered significant.
UNASSIGNED: 124 patients were included in the study; 62 in each group. At 9 weeks after surgery, statistically significantly improved pain control was reported by patients undergoing stemless aTSA, as assessed by the Visual Analog Scale (stemless: 1.5, stemmed: 2.5, P = .001), American Shoulder and Elbow Surgeons pain subscore (stemless: 42.4, stemmed: 37.3, P < .001), Western Ontario Osteoarthritis of the Shoulder Physical Symptoms (stemless: 80.3, stemmed: 73.1, P = .006) and Single Assessment Numeric Evaluation (stemless: 58.1, stemmed: 47.4, P = .011). Patients who underwent a stemless aTSA were significantly more likely to be able to sleep on the affected shoulder at 9 weeks (29% vs. 11%, odds ratio 3.2, 95% confidence interval 1.2-8.4, P = .014). By 26 weeks postoperatively, there were no differences in all pain-specific outcomes. At two years postoperatively, patient-reported outcomes, range of motion, and strength measures were all similar between the two cohorts.
UNASSIGNED: Stemless aTSA provides earlier improvement in postoperative shoulder pain compared to matched patients undergoing short-stem aTSA. Additionally, earlier return to sleeping on the affected shoulder was reported in the stemless aTSA group. The majority of these differences dissipate by 26 weeks postoperatively and there were no differences in pain, patient-reported outcomes, range of motion or strength measures between stemless and short-stem aTSA at 2 years postoperatively.
摘要：
■改善肩关节置换术后的疼痛控制并减少麻醉药的使用仍然是重要的术后目标。随着无茎解剖全肩关节置换术（aTSA）使用率的提高，有柄关节置换术和无柄关节置换术之间的比较是相关的,以评估这种植入物设计变更与术后早期疼痛之间是否存在关联.
■多中心患者，前瞻性维护的数据库对接受无茎性aTSA至少2年临床随访的患者进行了回顾性鉴定.在相同的注册表中确定了接受短茎aTSA的患者，按年龄与无茎的aTSA患者相匹配，性别和术前疼痛评分。主要研究结果是视觉模拟量表疼痛评分。次要疼痛结果是美国肩肘外科医生肩痛子评分，西部安大略省的肩关节骨性关节炎的身体症状子评分，和单一评估数字评估分数。最后,对每组可在受影响的肩关节上睡眠的患者百分比进行评估.术前评估和比较这些疼痛相关的临床结果，术后9周，26周,一年和两年。对于所有统计比较，P>0.05被认为是显著的。
■124例患者被纳入研究；每组62例。手术后9周，据报道，接受无茎aTSA的患者疼痛控制在统计学上显着改善，根据视觉模拟量表评估（无茎：1.5，茎：2.5，P=.001），美国肩肘外科医生疼痛评分（无茎：42.4，茎：37.3，P<.001），西部安大略省肩关节骨关节炎的身体症状（无茎：80.3，茎：73.1，P=.006）和单一评估数字评估（无茎：58.1，茎：47.4，P=.011）。接受无茎aTSA的患者在9周时更有可能在受影响的肩膀上睡觉（29％vs.11%,比值比3.2，95%置信区间1.2-8.4，P=0.014)。术后26周,所有疼痛特异性结局均无差异.术后两年，患者报告的结果，运动范围,两个队列之间的强度测量均相似.
■与接受短干aTSA的匹配患者相比，无茎aTSA在术后肩痛方面提供了更早的改善。此外,据报道,无茎aTSA组较早恢复在受影响的肩部睡觉.这些差异中的大多数在术后26周时消失，并且在疼痛方面没有差异，患者报告的结果，术后2年无茎和短茎aTSA之间的活动范围或强度测量。
■多中心患者，前瞻性维护的数据库对接受无茎性aTSA至少2年临床随访的患者进行了回顾性鉴定.在相同的注册表中确定了接受短茎aTSA的患者，按年龄与无茎的aTSA患者相匹配，性别和术前疼痛评分。主要研究结果是视觉模拟量表疼痛评分。次要疼痛结果是美国肩肘外科医生肩痛子评分，西部安大略省的肩关节骨性关节炎的身体症状子评分，和单一评估数字评估分数。最后,对每组可在受影响的肩关节上睡眠的患者百分比进行评估.术前评估和比较这些疼痛相关的临床结果，术后9周，26周,一年和两年。对于所有统计比较，P>0.05被认为是显著的。
■124例患者被纳入研究；每组62例。手术后9周，据报道，接受无茎aTSA的患者疼痛控制在统计学上显着改善，根据视觉模拟量表评估（无茎：1.5，茎：2.5，P=.001），美国肩肘外科医生疼痛评分（无茎：42.4，茎：37.3，P<.001），西部安大略省肩关节骨关节炎的身体症状（无茎：80.3，茎：73.1，P=.006）和单一评估数字评估（无茎：58.1，茎：47.4，P=.011）。接受无茎aTSA的患者在9周时更有可能在受影响的肩膀上睡觉（29％vs.11%,比值比3.2，95%置信区间1.2-8.4，P=0.014)。术后26周,所有疼痛特异性结局均无差异.术后两年，患者报告的结果，运动范围,两个队列之间的强度测量均相似.
■与接受短干aTSA的匹配患者相比，无茎aTSA在术后肩痛方面提供了更早的改善。此外,据报道,无茎aTSA组较早恢复在受影响的肩部睡觉.这些差异中的大多数在术后26周时消失，并且在疼痛方面没有差异，患者报告的结果，术后2年无茎和短茎aTSA之间的活动范围或强度测量。
