Levy Ofer, Funk Lennard, Sforza Giuseppe, Copeland Stephen A
Reading Shoulder Unit, Royal Berkshire Hospital, Reading RG1 5AN, United Kingdom.
J Bone Joint Surg Am. 2004 Mar;86(3):512-8. doi: 10.2106/00004623-200403000-00008.
Shoulder arthroplasty with a stemmed prosthesis is a recognized treatment for rheumatoid arthritis of the shoulder. The humeral component of the Copeland cementless surface replacement arthroplasty consists of a cup for surface replacement with a short central peg for primary fixation to the bone. We hypothesized that surface replacement may offer some advantages over stemmed prostheses.
Between 1986 and 1998, seventy-five shoulders underwent surface replacement arthroplasty (thirty-three hemiarthroplasties and forty-two total shoulder arthroplasties) for the treatment of rheumatoid arthritis. The results of these procedures were reviewed after an average duration of follow-up of 6.5 years. Patients were assessed with use of the Constant score, a patient satisfaction score, and radiographs.
The average Constant score was 47.9 points (age and sex-adjusted score, 71%) in the hemiarthroplasty group and 53.4 points (age and sex-adjusted score, 76%) in the total shoulder replacement group. The mean range of active flexion improved from 50 degrees in the hemiarthroplasty group and 47 degrees in the total shoulder replacement group to 101 degrees and 104 degrees, respectively. Seventy-two of the seventy-five shoulders were considered by the patients to be much better or better at the time of the review. Of the sixty-eight humeral implants that were evaluated radiographically, fifty-six (82%) showed no lucencies, eleven (16%) showed localized lucencies of <1 mm in width, and one was definitely loose. Of the thirty-nine glenoid implants that were evaluated radiographically, nineteen (49%) showed no lucencies, nineteen showed localized lucencies of <1 mm, and one was definitely loose. No lucencies were observed adjacent to the hydroxyapatite-coated implants. Thirty-nine (57%) of the sixty-eight shoulders showed some degree of superior subluxation. Three patients required a major reoperation: two required a revision because of loosening of both components, and one patient with pain at the site of a hemiarthroplasty had a revision to a total shoulder arthroplasty to provide relief.
The indications for this surface replacement are the same as those for the conventional stemmed prostheses, but the surface replacement has the advantage of bone preservation as well as avoidance of the potential complications associated with a long humeral stem in rheumatoid bone. This procedure is not suitable for severely damaged joints in which the humeral head is insufficient or too soft.
Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
带柄假体的肩关节置换术是公认的治疗肩部类风湿关节炎的方法。Copeland非骨水泥表面置换关节成形术的肱骨组件包括一个用于表面置换的杯状部件，带有一个短的中央栓钉，用于初次固定于骨。我们推测表面置换可能比带柄假体具有一些优势。
1986年至1998年间，75例肩部接受了表面置换关节成形术（33例半关节成形术和42例全肩关节置换术）以治疗类风湿关节炎。平均随访6.5年后对这些手术的结果进行了回顾。使用Constant评分、患者满意度评分和X线片对患者进行评估。
半关节成形术组的平均Constant评分为47.9分（年龄和性别调整评分，71%），全肩关节置换组为53.4分（年龄和性别调整评分，76%）。半关节成形术组主动屈曲的平均活动范围从50度提高到101度，全肩关节置换组从47度提高到104度。在复查时，75例肩部中有72例被患者认为明显好转或有所改善。在68个接受X线评估的肱骨植入物中，56个（82%）未显示透亮区，11个（16%）显示宽度<1mm的局限性透亮区，1个肯定松动。在39个接受X线评估的肩胛盂植入物中，19个（49%）未显示透亮区，19个显示宽度<1mm的局限性透亮区，1个肯定松动。在羟基磷灰石涂层植入物附近未观察到透亮区。68例肩部中有39例（57%）显示有一定程度的上半脱位。3例患者需要进行大的再次手术：2例因两个组件松动而需要翻修，1例半关节成形术部位疼痛的患者翻修为全肩关节置换术以缓解疼痛。
这种表面置换的适应证与传统带柄假体相同，但表面置换具有保留骨以及避免类风湿骨中长肱骨干相关潜在并发症的优势。该手术不适用于肱骨头不足或过软的严重受损关节。
治疗性研究，IV级（病例系列[无或历史对照组]）。有关证据水平的完整描述，请参阅作者须知。
