Abstract：
BACKGROUND: Reverse shoulder arthroplasty (RSA) is a well-recognized treatment for many shoulder conditions, including rotator cuff arthropathy, primary glenohumeral joint arthritis, and rheumatoid arthritis, and can be used in both trauma and revision settings. Over the past 10 years, its popularity in New Zealand has been increasing, with a 6%-7% annual growth rate during this period. Stemless RSA designs have the following proposed advantages: They can preserve humeral bone stock, they can limit periprosthetic fractures, and they can be indicated in patients with abnormal diaphyseal humeral anatomy. To date, only 1 study has evaluated the outcomes of the Lima SMR Stemless implant. We present our data with an aim to report how the stemless reverse arthroplasty compares to a conventional stemmed implant.
METHODS: We performed a retrospective review of a consecutive series of patients treated at a single institution between 2015 and 2020. The endpoint was defined as final follow-up at a minimum of 2 years. Patients were excluded from the final analysis if they underwent revision. Thirty-three patients were identified as having undergone stemless RSA. Thirty patients had patient-reported outcome measures and radiographs at a minimum of 2 years\' follow-up. Three patients had undergone revision within 2 years. The same sample size of stemmed RSAs (n = 33) was selected for comparison.
RESULTS: A total of 60 patients were included in the final analysis, of whom 30 underwent stemless RSA and 30 underwent stemmed RSA. The demographic characteristics of the 2 groups were comparable except age at operation, which showed a statistically significant difference (P = .001): 77 years (stemmed) vs. 65 years (stemless). The mean Oxford Shoulder Score was 40.1 in the stemless group vs. 40 in the stemmed group. The mean American Shoulder and Elbow Surgeons score was 72.9 in the stemless group vs. 79 in the stemmed group. Patient-reported outcome measures, pain scores, and satisfaction ratings were not statistically significantly different between the 2 groups. In terms of radiographic data, subsidence was observed in 2 patients in the stemless RSA group but the patients had no clinical symptoms. Also in the stemless RSA group, 1 patient had an acromial stress fracture and 1 patient had a superficial wound infection successfully treated with oral antibiotics. In terms of revisions in the stemless RSA group, 1 patient underwent revision owing to chronic infection, 1 underwent revision as a result of a periprosthetic fracture after a fall, and 1 underwent revision for gross instability.
CONCLUSIONS: The early results of sRSA are promising, and the stemless implant shows similar outcomes to a conventional stemmed implant.
METHODS: We performed a retrospective review of a consecutive series of patients treated at a single institution between 2015 and 2020. The endpoint was defined as final follow-up at a minimum of 2 years. Patients were excluded from the final analysis if they underwent revision. Thirty-three patients were identified as having undergone stemless RSA. Thirty patients had patient-reported outcome measures and radiographs at a minimum of 2 years\' follow-up. Three patients had undergone revision within 2 years. The same sample size of stemmed RSAs (n = 33) was selected for comparison.
RESULTS: A total of 60 patients were included in the final analysis, of whom 30 underwent stemless RSA and 30 underwent stemmed RSA. The demographic characteristics of the 2 groups were comparable except age at operation, which showed a statistically significant difference (P = .001): 77 years (stemmed) vs. 65 years (stemless). The mean Oxford Shoulder Score was 40.1 in the stemless group vs. 40 in the stemmed group. The mean American Shoulder and Elbow Surgeons score was 72.9 in the stemless group vs. 79 in the stemmed group. Patient-reported outcome measures, pain scores, and satisfaction ratings were not statistically significantly different between the 2 groups. In terms of radiographic data, subsidence was observed in 2 patients in the stemless RSA group but the patients had no clinical symptoms. Also in the stemless RSA group, 1 patient had an acromial stress fracture and 1 patient had a superficial wound infection successfully treated with oral antibiotics. In terms of revisions in the stemless RSA group, 1 patient underwent revision owing to chronic infection, 1 underwent revision as a result of a periprosthetic fracture after a fall, and 1 underwent revision for gross instability.
CONCLUSIONS: The early results of sRSA are promising, and the stemless implant shows similar outcomes to a conventional stemmed implant.
摘要：
目的：反向肩关节置换术（RSA）是许多肩关节疾病的公认治疗方法，包括肩袖关节病,原发性肱骨关节关节炎，类风湿性关节炎，可用于创伤和翻修设置。在过去的10年里，它在新西兰的受欢迎程度一直在增加，在此期间，年增长率为6-7%。提出的无茎（sRSA）设计的优点是保留肱骨原料，限制假体周围骨折，可用于肱骨干解剖异常的患者。迄今为止，只有一项研究评估了利马无茎SMR植入物的结果。我们提供了我们的数据，目的是报告无柄反向关节成形术与传统的柄植入物相比。
方法：在2015年至2020年之间，对单个机构的连续系列进行了回顾性审查。终点定义为至少2年的最终随访。如果患者进行了修正，则将其从最终分析中排除。33名患者被确定为患有sRSA。30例患者在至少2年的随访中接受了PROMS和X光片。3例患者在2年内进行了修正。选择相同样本量（n=33）的茎状RSA进行比较。结果：最终分析共纳入60例患者，其中30个无茎，30个有茎。除手术年龄差异有统计学意义(P=0.001)外,两组人口学特征具有可比性。77年（茎）vs65年（无茎）。无茎组的平均OSS评分为40.1，而有茎组的平均OSS评分为40。无茎组的ASES为72.9，有茎组的ASES为79。患者报告了结果指标，两组患者疼痛评分或满意度无统计学意义.就射线照相数据而言，观察到两个sRSA下沉，但患者没有临床症状。同样在sRSA组中，一名患者患有肩峰应力性骨折，一名患者的浅表伤口感染用口服抗生素成功治疗。就sRSA组的修订而言，一名患者因慢性感染进行了修正，一个因跌倒后假体周围骨折而进行了修订，另一个因严重不稳定而进行了修订。
结论：sRSA的早期结果是有希望的，并且显示出与传统的茎状植入物相似的结果。
方法：在2015年至2020年之间，对单个机构的连续系列进行了回顾性审查。终点定义为至少2年的最终随访。如果患者进行了修正，则将其从最终分析中排除。33名患者被确定为患有sRSA。30例患者在至少2年的随访中接受了PROMS和X光片。3例患者在2年内进行了修正。选择相同样本量（n=33）的茎状RSA进行比较。结果：最终分析共纳入60例患者，其中30个无茎，30个有茎。除手术年龄差异有统计学意义(P=0.001)外,两组人口学特征具有可比性。77年（茎）vs65年（无茎）。无茎组的平均OSS评分为40.1，而有茎组的平均OSS评分为40。无茎组的ASES为72.9，有茎组的ASES为79。患者报告了结果指标，两组患者疼痛评分或满意度无统计学意义.就射线照相数据而言，观察到两个sRSA下沉，但患者没有临床症状。同样在sRSA组中，一名患者患有肩峰应力性骨折，一名患者的浅表伤口感染用口服抗生素成功治疗。就sRSA组的修订而言，一名患者因慢性感染进行了修正，一个因跌倒后假体周围骨折而进行了修订，另一个因严重不稳定而进行了修订。
结论：sRSA的早期结果是有希望的，并且显示出与传统的茎状植入物相似的结果。
