背景:肩关节成形术已被广泛使用,并且多年来肩关节成形术的数量急剧增加。反向全肩关节成形术(rTSA)的使用迅速扩大,超过了解剖全肩关节成形术(aTSA)的适度增长,而肩关节成形术(HA)则呈下降趋势。最近,肩部假体已经过渡到越来越多的模块化系统,提供更多的个性化选择,有可能减少疼痛和增加运动范围。然而,初级程序的增加导致了翻修手术的增加,一个潜在的原因是这些模块化系统内的微动和腐蚀损坏。
方法:在IRB批准后,通过数据库查询鉴定130个检索的aTSA和135个HA外植体。肱骨干和头部组件包括在所有265个外植体中,而108包括聚乙烯(PE)关节盂衬垫组件。使用改良的Goldberg-Cusick分类系统对所有外植的组件进行了标准损伤模式的宏观评估,并对锥形接头进行了微动/腐蚀检查,该系统对男性和女性组件进行了4个象限分级。对病历进行了审查,以了解患者的人口统计学和手术信息。
结果:在本系列中,158个外植体来自女性患者(男性=107),162个外植体来自右肩。植入的平均年龄为61岁(范围:24-83),解释的平均年龄为66岁(范围,32-90),平均植入时间(DOI)为61.4个月(范围,0.5-240)。刮伤,边缘变形,和抛光是最常见的标准损伤模式,如(图1)所示。在265个外植体中,146有一个男性茎组件与118带有雌性茎组件。雄性和雌性茎组分的平均总微动等级分别为8.3和5.9(p<0.001)。男性和女性茎组件的平均总腐蚀等级分别为8.2和6.2(p<0.001)。较宽的男性锥形(>11mm)显示出显著较少的微动和腐蚀(p<0.001)。最后,头部和杆部件之间不匹配的金属成分显示出更大的微动和腐蚀损伤(p=0.002)。
结论:在这一系列265个ATSA和HA外植体中,移植的组件上存在大量损坏。所有组件都显示出宏观损伤。在这项检索研究中,小锥形雄茎,女性头部薄和部件间金属成分不匹配是植入物磨损增加的危险因素.随着肩关节成形术体积的增加,优化设计对于长期成功至关重要。其他工作可以确定这些发现的临床意义。
BACKGROUND: Shoulder arthroplasty procedures are widely indicated, and the number of shoulder arthroplasty procedures has drastically increased over the years. Rapid expansion of the utilization of reverse total shoulder arthroplasty has outpaced the more modest growth of anatomic total shoulder arthroplasty (aTSA) while shoulder hemiarthroplasty (HA) has trended down. Recently, shoulder prostheses have transitioned to increasingly modular systems offering more individualized options with the potential for decreased pain and increased range of motion. However, increased primary procedures has resulted in increased revision surgeries, with one potential cause being
fretting and corrosion damage within these modular systems.
METHODS: Following institutional review board approval, 130 retrieved aTSA and 135 HA explants were identified through database query. Humeral stem and head components were included in all 265 explants, whereas 108 included polyethylene glenoid liner components. All explanted components were macroscopically evaluated for standard damage modes, and taper junctions were microscopically examined for
fretting/corrosion using a modified Goldberg-Cusick classification system that was 4-quadrant graded for both the male and female component. Medical records were reviewed for patient demographics and surgical information.
RESULTS: In this series, 158 of explants were from female patients (male = 107), and 162 explants were from the right shoulder. Average age at implantation was 61 years (range: 24-83), average age at explanation was 66 years (range, 32-90), and average duration of implantation was 61.4 months (range, 0.5-240). Scratching, edge deformation, and burnishing were the most commonly observed standard damage modes. Of the 265 explants, 146 had a male stem component vs. 118 with a female stem component. Average summed
fretting grades on male and female stem components were 8.3 and 5.9, respectively (P < .001). Average summed corrosion grades for male and female stem components were 8.2 and 6.2, respectively (P < .001). Wider male tapers (>11 mm) showed significantly less
fretting and corrosion (P < .001). Lastly, mismatched metal compositions between the head and stem components showed greater
fretting and corrosion damage (P = .002).
CONCLUSIONS: In this series of 265 aTSA and HA explants, there was substantial damage present on the explanted components. All components demonstrated macroscopic damage. In this retrieval study, small-tapered male stems with small, thin female heads and mismatched metal composition between components were risk factors for increased implant wear. As shoulder arthroplasty volume increases, optimizing design is paramount for long-term success. Additional work could determine the clinical significance of these findings.