Southern Oregon Orthopedics, Medford, OR, USA.
J Shoulder Elbow Surg. 2013 Jul;22(7):894-900. doi: 10.1016/j.jse.2012.09.016. Epub 2013 Jan 9.
The purpose of this study was to examine the mid- to long-term functional outcome and implant survival of total shoulder arthroplasty (TSA) in adults aged 55 years or younger with primary glenohumeral arthritis. The hypothesis was that TSA would lead to improvement in functional outcome but that implant survival would decline between 5 years and 10 years postoperatively.
Between 1992 and 2004, 52 TSAs were implanted in 8 centers for primary glenohumeral arthritis in patients aged 55 years or younger. Minimum follow-up of 5 years was available in 50 patients at a mean of 115.5 months postoperatively. Kaplan-Meier survivorship analysis was performed, and clinical outcome was assessed.
After TSA, adjusted Constant scores improved from 37.0% to 73.4% and forward flexion improved from 97° to 128° (P < .001). The adjusted Constant score was 80.0 in patients free of revision of the glenoid compared with 43.6 in the group requiring revision of the glenoid (P < .001). Survivorship of the glenoid component with revision surgery for glenoid loosening as the endpoint was 98% (95% confidence interval, 89.4%-100%) at 5 years and 62.5% (95% confidence interval, 40.6%-81.2%) at 10 years. Factors associated with survival of the glenoid included anatomic humeral component positioning and a compaction glenoid preparation technique.
At 5 years' follow-up, TSA leads to improvement in functional outcome and a satisfactory implant survival rate of 98% in young adults with primary glenohumeral arthritis. However, the 10-year survival rate of TSA was only 62.5% in patients aged 55 years or younger at the time of surgery.
本研究旨在探讨原发性肩关节炎患者中年龄在 55 岁及以下行全肩关节置换术（TSA）的中期至长期功能结果和植入物存活率。假设是 TSA 将改善功能结果，但植入物存活率将在术后 5 年至 10 年内下降。
1992 年至 2004 年间，在 8 个中心为 55 岁及以下的原发性肩关节炎患者进行了 52 例 TSA 植入术。在术后平均 115.5 个月时，50 例患者获得了至少 5 年的随访。进行了 Kaplan-Meier 生存分析，并评估了临床结果。
行 TSA 后，调整后的 Constant 评分从 37.0%提高到 73.4%，前屈从 97°提高到 128°（P<.001）。与需要行肩胛盂翻修的患者（43.6）相比，无肩胛盂翻修的患者（80.0）调整后的 Constant 评分更高（P<.001）。以肩胛盂松动为翻修手术终点的肩胛盂组件的生存，在 5 年时为 98%（95%置信区间，89.4%-100%），在 10 年时为 62.5%（95%置信区间，40.6%-81.2%）。与肩胛盂生存相关的因素包括解剖学肱骨头组件定位和压缩肩胛盂准备技术。
在 5 年的随访中，TSA 可改善功能结果，原发性肩关节炎年轻患者的植入物存活率为 98%，令人满意。然而，在手术时年龄在 55 岁及以下的患者中，TSA 的 10 年生存率仅为 62.5%。
