Fevang Bjørg-Tilde S, Lie Stein A, Havelin Leif I, Skredderstuen Arne, Furnes Ove
Department of Rheumatology and The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway.
Acta Orthop. 2009 Feb;80(1):83-91. doi: 10.1080/17453670902805098.
Previous studies on shoulder arthroplasty have usually described small patient populations, and few articles have addressed the survival of shoulder implants. We describe the results of shoulder replacement in the Norwegian population (of 4.7 million) during a 12-year period. Trends in the use of shoulder arthroplasty during the study period were also investigated.
1,531 hemiprostheses (HPs), 69 total shoulder replacements (Neer type TSR), and 225 reversed total shoulder replacement (reversed TSR) operations were reported to the Norwegian Arthroplasty Register between 1994 and 2005. Kaplan-Meier failure curves were drawn up for particular subgroups of patients, and revision rates were calculated using Cox regression analysis.
The 5- and 10-year failure rates of hemiprostheses were 6% (95% CI: 5-7) and 8% (95% CI: 6-10), and for reversed total shoulder replacements they were 10% (95% CI: 5-15) and 22% (95% CI: 10-33), respectively. For hemiprostheses, the risk of revision for patients who were 70 years or older was half that of those who were younger (RR = 0.47, CI: 0.28-0.77), while the risk of revision was highest for patients with sequelae after fracture compared to those with acute fractures (RR = 3.3, CI: 1.5-7.2). No differences in prosthesis survival were found between the different hemiprosthesis brands. The main reasons for revision of hemiprostheses were pain and luxation. For reversed total prostheses, the risk of revision was less for women than for men (RR = 0.26, CI: 0.11-0.63), and the main cause of revision was aseptic loosening of the glenoid component. During the study period, the incidence of shoulder arthroplasty increased for all diagnostic groups except inflammatory arthritis, for which a decrease was seen.
We found good results in terms of 5-year prosthesis failure rate, with the use of hemiarthroplasty for patients with inflammatory arthritis, osteoarthritis, and acute fractures. Reversed total shoulder replacement was associated with a rather poor prognosis.
以往关于肩关节置换术的研究通常描述的是小规模患者群体，很少有文章涉及肩部植入物的生存率。我们描述了挪威470万人口在12年期间肩关节置换的结果。还研究了研究期间肩关节置换术的使用趋势。
1994年至2005年期间，向挪威关节置换登记处报告了1531例半关节置换术（HP）、69例全肩关节置换术（Neer型TSR）和225例反式全肩关节置换术（反式TSR）。为特定亚组患者绘制了Kaplan-Meier失败曲线，并使用Cox回归分析计算翻修率。
半关节置换术的5年和10年失败率分别为6%（95%CI：5-7）和8%（95%CI：6-10），反式全肩关节置换术的5年和10年失败率分别为10%（95%CI：5-15）和22%（95%CI：10-33）。对于半关节置换术，70岁及以上患者的翻修风险是年轻患者的一半（RR = 0.47，CI：0.28-0.77），而骨折后遗症患者的翻修风险高于急性骨折患者（RR = 3.3，CI：1.5-7.2）。不同半关节置换品牌之间的假体生存率没有差异。半关节置换术翻修的主要原因是疼痛和脱位。对于反式全肩关节置换术，女性的翻修风险低于男性（RR = 0.26，CI：0.11-0.63），翻修的主要原因是关节盂组件的无菌性松动。在研究期间，除炎症性关节炎外，所有诊断组的肩关节置换术发病率均有所增加，而炎症性关节炎的发病率有所下降。
我们发现，就5年假体失败率而言，对于炎症性关节炎、骨关节炎和急性骨折患者使用半关节置换术取得了良好效果。反式全肩关节置换术的预后相当差。
