背景:解剖全肩关节置换术(TSA)是各种肩关节病变的常见外科干预措施,主要是肱骨关节炎。虽然通常被认为是安全有效的,并发症仍然是一个挑战。短茎植入物,旨在保持骨骼储备并减少并发症。然而,对特定短茎植入物的关注(UniversApex;Arthrex,那不勒斯,FL,美国)由于报道较高的相对早期的无菌性松动率而浮出水面。
方法:这项回顾性研究分析了2004年至2022年连续116例接受UniversApex植入物的TSA患者。评估了15例翻修病例的放射学松动,使用0-3量表检查移植的植入物的损伤。组织病理学分析评估了细胞对磨损碎片的反应。
结果:在患者中,13%(15/116)平均23.2个月需要修订。确定了明显的射线照相松动模式,肱骨成分下沉和肱骨近端皮质变薄。组织病理学显示磨损碎片有强烈的炎症反应,与巨噬细胞浸润之间的潜在关联,铰链损坏,和聚乙烯磨损。
结论:这项研究揭示了使用UniversApex短茎植入物的早期无菌性肱骨松动的显着比率,强调以前报告中提出的担忧,并为早期失败率高提供潜在的解释。外科医生应谨慎行事,并密切监测这种植入物设计的患者。
BACKGROUND: Anatomic total shoulder arthroplasty (TSA) is a common surgical intervention for various shoulder pathologies, predominantly glenohumeral osteoarthritis. While generally considered safe and effective, complications remain a challenge. Short stem implants, aim to preserve bone stock and reduce complications. However, concerns about a specific short stem implant (Univers Apex; Arthrex, Naples, FL, USA) have surfaced due to high reported rates relatively early aseptic loosening.
METHODS: This retrospective study analyzed 116 consecutive TSA patients with Univers Apex implants from 2004 to 2022. 15 revision cases were assessed for radiographic loosening, and explanted implants were examined for damage using a 0-3 scale. Histopathological analysis evaluated cellular responses to wear debris.
RESULTS: Of the patients, 13% (15/116) required revision at 23.2 months on average. A distinct radiographic loosening pattern was identified, with humeral component subsidence and thinning of the proximal humeral cortex. Histopathology revealed a robust inflammatory response to wear debris, with a potential association between macrophage infiltration, hinge damage, and polyethylene wear.
CONCLUSIONS: This study reveals a notable rate of early aseptic humeral loosening with the Univers Apex short stem implant, emphasizing concerns raised in previous reports and providing a potential explanation for the high rate of early failure. Surgeons should exercise caution and closely monitor patients with this implant design.