Abstract：
BACKGROUND: Patients who rely on their upper extremities for ambulation, or upper extremity ambulators (UEAs), place considerable stress on their shoulders through the use of assistive devices like walkers, crutches, canes, and wheelchairs. It has been postulated that UEAs may be at increased risk for complications following shoulder arthroplasty. This study aimed to systematically review the literature related to (1) patient-reported outcomes measures (PROMs), (2) functional outcomes, and (3) complications in UEAs who undergo shoulder arthroplasty.
METHODS: A systematic review of the PubMed/MEDLINE, Embase, and Cochrane databases was performed to identify studies reporting clinical outcomes of shoulder arthroplasty in UEAs. Patient demographics, clinical characteristics, patient-reported outcomes measures, radiographic outcomes, and postoperative range of motion were collected and compared to control patients (ie bipedal ambulators) from the constituent studies.
RESULTS: A total of eight studies evaluating 248 UEA cases and 206 control cases were included for review. Ambulatory assistive devices utilized by UEAs included walkers (39%), wheelchairs (38%), canes (22%), and a crutch (<1%). Among UEA cases, 197 (79%) reverse total shoulder arthroplasty (TSA), 37 (15%) anatomic TSA, and 14 (6%) hemiarthroplasty were performed. Overall, patients exhibited significant improvements in mean American Shoulder and Elbow Surgeons scores, Constant-Murley scores, Simple Shoulder Test scores, and Visual Analog Scale scores postoperatively. Among 3 studies that included comparison with control groups of bipedal ambulators, no significant differences in outcomes were identified. The overall clinical complication rate was 17% for UEAs compared to 9.1% for controls. The rate of revision surgery was 7.7% for UEAs and 4.9% for bipedal ambulators.
CONCLUSIONS: UEAs experience satisfactory pain relief, functional improvements, and good subjective outcomes following shoulder arthroplasty. However, complication and revision rates are higher compared to those for bipedal ambulators, and the majority of UEAs undergo reverse shoulder arthroplasty compared to anatomic TSA.
METHODS: A systematic review of the PubMed/MEDLINE, Embase, and Cochrane databases was performed to identify studies reporting clinical outcomes of shoulder arthroplasty in UEAs. Patient demographics, clinical characteristics, patient-reported outcomes measures, radiographic outcomes, and postoperative range of motion were collected and compared to control patients (ie bipedal ambulators) from the constituent studies.
RESULTS: A total of eight studies evaluating 248 UEA cases and 206 control cases were included for review. Ambulatory assistive devices utilized by UEAs included walkers (39%), wheelchairs (38%), canes (22%), and a crutch (<1%). Among UEA cases, 197 (79%) reverse total shoulder arthroplasty (TSA), 37 (15%) anatomic TSA, and 14 (6%) hemiarthroplasty were performed. Overall, patients exhibited significant improvements in mean American Shoulder and Elbow Surgeons scores, Constant-Murley scores, Simple Shoulder Test scores, and Visual Analog Scale scores postoperatively. Among 3 studies that included comparison with control groups of bipedal ambulators, no significant differences in outcomes were identified. The overall clinical complication rate was 17% for UEAs compared to 9.1% for controls. The rate of revision surgery was 7.7% for UEAs and 4.9% for bipedal ambulators.
CONCLUSIONS: UEAs experience satisfactory pain relief, functional improvements, and good subjective outcomes following shoulder arthroplasty. However, complication and revision rates are higher compared to those for bipedal ambulators, and the majority of UEAs undergo reverse shoulder arthroplasty compared to anatomic TSA.
摘要：
背景：依赖上肢行走的患者，或上肢救护车（UEAs），通过使用助行器等辅助设备在他们的肩膀上施加相当大的压力，拐杖,手杖,和轮椅。据推测，肩关节置换术后，UEA可能会增加并发症的风险。本研究旨在系统回顾与(1)患者报告结局指标(PROMs)相关的文献，(2)功能成果，（3）接受肩关节置换术的UEA的并发症。
方法：对PubMed/MEDLINE的系统评价，Embase,和Cochrane数据库用于确定报告UEA肩关节置换术临床结局的研究.患者人口统计学，临床特征,PROMs,射线照相结果，收集和术后活动范围,并与组成研究中的对照患者(即双足救护车)进行比较.
结果：共纳入8项研究，评估248例UEA病例和206例对照病例。UEA使用的门诊辅助设备包括步行者（39％），轮椅(38%),手杖（22%），和拐杖（<1％）。在UEA案例中，197（79%）反向全肩关节置换术，37（15%）解剖全肩关节置换术，进行了14例（6％）半髋关节置换术。总的来说,患者的平均美国肩肘外科医生（ASES）评分显着改善，Constant-Murley得分,单肩测试（SST）成绩，术后视觉模拟量表(VAS)评分。在3项研究中，包括与双足救护车对照组的比较，在结局方面没有发现显著差异.UEAs的总体临床并发症发生率为17％，而对照组为9.1％。UEA的翻修手术率为7.7％，双足救护车的翻修手术率为4.9％。
结论：UEAs疼痛缓解令人满意，功能改进，肩关节置换术后主观效果良好。然而,与双足救护车相比，并发症和翻修率更高，与解剖全肩关节置换术（aTSA）相比，大多数UEA接受反向肩关节置换术（RSA）。
方法：对PubMed/MEDLINE的系统评价，Embase,和Cochrane数据库用于确定报告UEA肩关节置换术临床结局的研究.患者人口统计学，临床特征,PROMs,射线照相结果，收集和术后活动范围,并与组成研究中的对照患者(即双足救护车)进行比较.
结果：共纳入8项研究，评估248例UEA病例和206例对照病例。UEA使用的门诊辅助设备包括步行者（39％），轮椅(38%),手杖（22%），和拐杖（<1％）。在UEA案例中，197（79%）反向全肩关节置换术，37（15%）解剖全肩关节置换术，进行了14例（6％）半髋关节置换术。总的来说,患者的平均美国肩肘外科医生（ASES）评分显着改善，Constant-Murley得分,单肩测试（SST）成绩，术后视觉模拟量表(VAS)评分。在3项研究中，包括与双足救护车对照组的比较，在结局方面没有发现显著差异.UEAs的总体临床并发症发生率为17％，而对照组为9.1％。UEA的翻修手术率为7.7％，双足救护车的翻修手术率为4.9％。
结论：UEAs疼痛缓解令人满意，功能改进，肩关节置换术后主观效果良好。然而,与双足救护车相比，并发症和翻修率更高，与解剖全肩关节置换术（aTSA）相比，大多数UEA接受反向肩关节置换术（RSA）。
