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Abstract：
BACKGROUND: The two major reverse shoulder arthroplasty (RSA) designs are the Grammont design and the lateralized design. Even if the lateralized design is biomechanically favored, the classic Grammont prosthesis continues to be used. Functional and subjective patient scores as well as implant survival described in the literature so far are comparable to the lateralized design. A pure comparison of how the RSA design influences outcome in patients has not yet been determined. The aim of this study was a comparison focused on patients with cuff tear arthropathy (CTA).
METHODS: We analyzed registry data from 696 CTA patients prospectively collected between 2012 and 2020 in two specialized orthopedic centers up to 2 years post-RSA with the same follow-up time points (6,12 24 months). Complete teres minor tears were excluded. Three groups were defined: group 1 (inlay, 155° humeral inclination, 36 + 2 mm eccentric glenosphere (n = 50)), group 2 (inlay, 135° humeral inclination, 36 + 4 mm lateralized glenosphere (n = 141)) and group 3 (onlay, 145° humeral inclination, + 3 mm lateralized base plate, 36 + 2 mm eccentric glenosphere (n = 35)) We compared group differences in clinical outcomes (e.g., active and passive range of motion (ROM), abduction strength, Constant-Murley score (CS)), radiographic evaluations of prosthetic position, scapular anatomy and complications using mixed models adjusted for age and sex.
RESULTS: The final analysis included 226 patients. The overall adjusted p-value of the CS for all time-points showed no significant difference (p = 0.466). Flexion of group 3 (mean, 155° (SD 13)) was higher than flexion of group 1 (mean, 142° (SD 18) and 2 (mean, 132° (SD 18) (p < 0.001). Values for abduction of group 3 (mean, 145° (SD 23)) were bigger than those of group 1 (mean, 130° (SD 22)) and group 2 (mean, 118° (SD 25)) (p < 0.001). Mean external rotation for group 3 (mean, 41° (SD 23)) and group 2 (mean, 38° (SD 17)) was larger than external rotation of group 1 (mean, 24° (SD 16)) (p < 0.001); a greater proportion of group 2 (78%) and 3 (69%) patients reached L3 level on internal rotation compared to group 1 (44%) (p = 0.003). Prosthesis position measurements were similar, but group 3 had significantly less scapular notching (14%) versus 24% (group 2) and 50% (group 1) (p = 0.001).
CONCLUSIONS: Outcome scores of different RSA designs for CTA revealed comparable results. However, CTA patients with a lateralized and distalized RSA configuration were associated with achieving better flexion and abduction with less scapular notching. A better rotation was associated with either of the lateralized RSA designs in comparison with the classic Grammont prosthesis.
METHODS: Therapeutic study, Level III.
METHODS: We analyzed registry data from 696 CTA patients prospectively collected between 2012 and 2020 in two specialized orthopedic centers up to 2 years post-RSA with the same follow-up time points (6,12 24 months). Complete teres minor tears were excluded. Three groups were defined: group 1 (inlay, 155° humeral inclination, 36 + 2 mm eccentric glenosphere (n = 50)), group 2 (inlay, 135° humeral inclination, 36 + 4 mm lateralized glenosphere (n = 141)) and group 3 (onlay, 145° humeral inclination, + 3 mm lateralized base plate, 36 + 2 mm eccentric glenosphere (n = 35)) We compared group differences in clinical outcomes (e.g., active and passive range of motion (ROM), abduction strength, Constant-Murley score (CS)), radiographic evaluations of prosthetic position, scapular anatomy and complications using mixed models adjusted for age and sex.
RESULTS: The final analysis included 226 patients. The overall adjusted p-value of the CS for all time-points showed no significant difference (p = 0.466). Flexion of group 3 (mean, 155° (SD 13)) was higher than flexion of group 1 (mean, 142° (SD 18) and 2 (mean, 132° (SD 18) (p < 0.001). Values for abduction of group 3 (mean, 145° (SD 23)) were bigger than those of group 1 (mean, 130° (SD 22)) and group 2 (mean, 118° (SD 25)) (p < 0.001). Mean external rotation for group 3 (mean, 41° (SD 23)) and group 2 (mean, 38° (SD 17)) was larger than external rotation of group 1 (mean, 24° (SD 16)) (p < 0.001); a greater proportion of group 2 (78%) and 3 (69%) patients reached L3 level on internal rotation compared to group 1 (44%) (p = 0.003). Prosthesis position measurements were similar, but group 3 had significantly less scapular notching (14%) versus 24% (group 2) and 50% (group 1) (p = 0.001).
CONCLUSIONS: Outcome scores of different RSA designs for CTA revealed comparable results. However, CTA patients with a lateralized and distalized RSA configuration were associated with achieving better flexion and abduction with less scapular notching. A better rotation was associated with either of the lateralized RSA designs in comparison with the classic Grammont prosthesis.
METHODS: Therapeutic study, Level III.
摘要：
背景：两种主要的反向肩关节成形术（RSA）设计是Grammont设计和侧向设计。即使横向设计在生物力学上受到青睐，继续使用经典的Grammont假体。迄今为止，文献中描述的功能和主观患者评分以及植入物存活率与横向设计相当。尚未确定RSA设计如何影响患者预后的纯粹比较。这项研究的目的是对袖带撕裂性关节病（CTA）患者进行比较。
方法：我们分析了2012年至2020年在两个专业骨科中心前瞻性收集的696名CTA患者的注册数据，随访时间点相同（6,12-24个月）。完全圆的轻微眼泪被排除。定义了三组：第1组（嵌体，肱骨倾角155°,36+2毫米偏心球球（n=50）），第2组(嵌体，肱骨倾角135°,36+4毫米的侧向关节盂球(n=141)和第3组(高嵌体，肱骨倾角145°,+3mm侧向底板，36+2毫米偏心性腺球（n=35）我们比较了临床结果的组间差异（例如，主动和被动运动范围(ROM)，绑架强度,Constant-Murley得分(CS)),假体位置的射线照相评估，使用根据年龄和性别调整的混合模型的肩胛骨解剖结构和并发症。
结果：最终分析包括226名患者。所有时间点的CS的总体调整p值没有显着差异（p=0.466）。第3组的屈曲(平均，155°（SD13））高于第1组的屈曲（平均值，142°(SD18)和2(平均值，132°(SD18)(p<0.001)。第3组外展值(平均值，145°（SD23））大于第1组（平均值，130°（SD22）和第2组（平均值，118°(SD25))(p<0.001)。第3组的平均外部旋转（平均值，41°（SD23）和第2组（平均值，38°（SD17））大于第1组的外部旋转（平均值，24°（SD16））（p<0.001）；与第1组（44％）相比，第2组（78％）和3组（69％）患者在内部旋转时达到L3水平的比例更大（p=0.003）。假体位置测量相似，但第3组的肩胛骨切口(14%)明显少于24%(第2组)和50%(第1组)(p=0.001).
结论：CTA的不同RSA设计的结果评分显示出相当的结果。然而,具有横向和远端RSA构型的CTA患者与获得更好的屈曲和外展相关，肩胛骨切口较少。与经典的Grammont假体相比，任何一种侧向RSA设计都具有更好的旋转。
方法：治疗性研究，三级。
方法：我们分析了2012年至2020年在两个专业骨科中心前瞻性收集的696名CTA患者的注册数据，随访时间点相同（6,12-24个月）。完全圆的轻微眼泪被排除。定义了三组：第1组（嵌体，肱骨倾角155°,36+2毫米偏心球球（n=50）），第2组(嵌体，肱骨倾角135°,36+4毫米的侧向关节盂球(n=141)和第3组(高嵌体，肱骨倾角145°,+3mm侧向底板，36+2毫米偏心性腺球（n=35）我们比较了临床结果的组间差异（例如，主动和被动运动范围(ROM)，绑架强度,Constant-Murley得分(CS)),假体位置的射线照相评估，使用根据年龄和性别调整的混合模型的肩胛骨解剖结构和并发症。
结果：最终分析包括226名患者。所有时间点的CS的总体调整p值没有显着差异（p=0.466）。第3组的屈曲(平均，155°（SD13））高于第1组的屈曲（平均值，142°(SD18)和2(平均值，132°(SD18)(p<0.001)。第3组外展值(平均值，145°（SD23））大于第1组（平均值，130°（SD22）和第2组（平均值，118°(SD25))(p<0.001)。第3组的平均外部旋转（平均值，41°（SD23）和第2组（平均值，38°（SD17））大于第1组的外部旋转（平均值，24°（SD16））（p<0.001）；与第1组（44％）相比，第2组（78％）和3组（69％）患者在内部旋转时达到L3水平的比例更大（p=0.003）。假体位置测量相似，但第3组的肩胛骨切口(14%)明显少于24%(第2组)和50%(第1组)(p=0.001).
结论：CTA的不同RSA设计的结果评分显示出相当的结果。然而,具有横向和远端RSA构型的CTA患者与获得更好的屈曲和外展相关，肩胛骨切口较少。与经典的Grammont假体相比，任何一种侧向RSA设计都具有更好的旋转。
方法：治疗性研究，三级。
