背景:解剖和反向全肩关节置换术(aTSA,rTSA)是原发性骨关节炎和完整袖带患者的公认治疗方法。然而,目前尚不清楚aTSA或rTSA在术前外旋转(ER)无力患者中是否能提供更优的结局.
方法:对2007-2020年间前瞻性收集的肩关节置换术数据库进行了回顾性回顾。术前诊断为神经损伤的患者被排除在外,感染,肿瘤,或骨折。分析包括针对原发性袖带完整骨关节炎进行的333个aTSA和155个rTSA,最少随访2年。术前ER弱点定义为强度≤7.2磅,创建并匹配3个队列:1)弱aTSA(n=74)与正常aTSA(n=74),2)弱rTSA(n=38)与正常rTSA(n=38),和3)弱rTSA(n=60)对弱aTSA(n=60)。我们比较了ROM,结果分数,力量,并发症,和最新随访的修订率。
结果:尽管弱的aTSA在FE和ER的术前强度较差(P<.001),与正常队列相比,这些缺陷均未在术后持续.同样,弱rTSA在FE和ER的术前强度较差,头顶运动,和常数,SPADI,加州大学洛杉矶分校得分(P<.029)。然而,术前弱rTSA和正常rTSA之间无统计学差异。比较弱aTSA和弱rTSA时,术前和术后结局没有差异,达到MCID和SCB的患者比例,并发症和翻修手术率。
结论:在术前患有袖套完整原发性骨关节炎的虚弱患者中,aTSA导致类似的术后强度,ROM,与术前力量正常的患者相比,提示术前虚弱并不排除使用aTSA。此外,术前ER弱的患者在接受aTSA和rTSA后表现出术后旋转运动改善,两组以相似的速率实现MCID和SCB。
BACKGROUND: Anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) are well-established treatments for patients with primary osteoarthritis and an intact cuff. However, it is unclear whether aTSA or rTSA provides superior outcomes in patients with preoperative external rotation (ER) weakness.
METHODS: A retrospective review of a prospectively collected shoulder arthroplasty database was performed between 2007 and 2020. Patients were excluded for preoperative diagnoses of nerve injury, infection, tumor, or fracture. The analysis included 333 aTSAs and 155 rTSAs performed for primary cuff-intact osteoarthritis with 2-year minimum follow-up. Defining preoperative ER weakness as strength <3.3 kilograms (7.2 pounds), 3 cohorts were created and matched: (1) weak aTSAs (n = 74) vs. normal aTSAs (n = 74), (2) weak rTSAs (n = 38) vs. normal rTSAs (n = 38), and (3) weak rTSAs (n = 60) vs. weak aTSAs (n = 60). We compared range of motion, outcome scores, strength, complications, and revision rates at the latest follow-up.
RESULTS: Despite weak aTSAs having poorer preoperative strength in forward elevation and ER (P < .001), neither of these deficits persisted postoperatively compared with the normal cohort. Likewise, weak rTSAs had poorer preoperative strength in forward elevation and ER, overhead motion, and Constant, Shoulder Pain and Disability Index, and University of California, Los Angeles scores (P < .029). However, no statistically significant differences were found between preoperatively weak and normal rTSAs. When comparing weak aTSA vs. weak rTSA, no differences were found in preoperative and postoperative outcomes, proportion of patients achieving the minimal clinically important difference and substantial clinical benefit, and complication and rate of revision surgery.
CONCLUSIONS: In preoperatively weak patients with cuff-intact primary osteoarthritis, aTSA leads to similar postoperative strength, range of motion, and outcome scores compared with patients with normal preoperative strength, indicating that preoperative weakness does not preclude aTSA use. Furthermore, patients who were preoperatively weak in ER demonstrated improved postoperative rotational motion after undergoing aTSA and rTSA, with both groups achieving the minimal clinically important difference and substantial clinical benefit at similar rates.