Hattrup Steven J
Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
J Shoulder Elbow Surg. 2009 Mar-Apr;18(2):220-4. doi: 10.1016/j.jse.2008.09.006. Epub 2008 Dec 18.
After humeral head replacement, revision total shoulder arthroplasty may become necessary for painful glenoid arthrosis. The hypothesis of this study was revision surgery would significantly relieve the patients' pain.
This report retrospectively reviewed the results of revision total shoulder arthroplasty in seventeen patients with a painful humeral head replacement and glenoid arthrosis. The mean time interval to revision was 36.4 months (6-144) and the patients were followed for an average of 56.1 months (24-119). Outcomes were graded with the Neer classification.
There were 7 (41.2%) excellent, 5 (29.4%) satisfactory, and 5 (29.4%) unsatisfactory results. The visual analogue pain score decreased from 8.8 to 2.4, flexion improved from 73 degrees to 124, abduction from 63 to 115.6, and external rotation from 12.1 to 46.8. In 13 shoulders with sufficient data, the ASES score was 76.8 and the SST 9.5. It was necessary to revise the humeral stem in 12 of the 17 procedures, typically for poor stem position or improved exposure.
Conversion of humeral head replacement to total shoulder arthroplasty can be accomplished with excellent results, but the surgery is complex and unsatisfactory results are frequent.
Level 4; Retrospective case series, no control group.
肱骨头置换术后，因疼痛性关节盂关节炎可能需要进行翻修全肩关节置换术。本研究的假设是翻修手术能显著缓解患者疼痛。
本报告回顾性分析了17例因肱骨头置换术后疼痛且伴有关节盂关节炎而行翻修全肩关节置换术患者的结果。翻修的平均时间间隔为36.4个月（6 - 144个月），患者平均随访56.1个月（24 - 119个月）。结果采用Neer分类法进行分级。
结果为优的有7例（41.2%），良的有5例（29.4%），差的有5例（29.4%）。视觉模拟疼痛评分从8.8降至2.4，屈曲从73度改善至124度，外展从63度改善至115.6度，外旋从12.1度改善至46.8度。在13例有足够数据的肩关节中，ASES评分为76.8，SST评分为9.5。17例手术中有12例需要翻修肱骨干，通常是因为肱骨干位置不佳或为了更好地暴露。
将肱骨头置换转换为全肩关节置换术可取得良好效果，但手术复杂，不满意的结果很常见。
4级；回顾性病例系列，无对照组。
