Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
J Shoulder Elbow Surg. 2013 Jul;22(7):886-93. doi: 10.1016/j.jse.2012.09.008. Epub 2013 Jan 10.
Humeral head variations were developed based on anatomic and biomechanical advantages; however, the effect of this expanded prosthetic inventory has yet to be investigated clinically. This study seeks to determine whether prosthetic variety has led to better outcomes, has led to similar outcomes facilitating joint reconstruction, or created any unanticipated complications.
One hundred sixty primary total shoulder arthroplasties were performed for osteoarthritis. Patients received 52 standard, 60 eccentric, and 48 offset humeral heads. Head geometry was selected intraoperatively during trialing based on a complementing relationship to the glenoid throughout a near-normal range of motion. Patients had 2 years of follow-up or follow-up until reoperation (mean, 4.7 years; range, 0.8-8.3 years).
Mean pain scores decreased from 4.5 to 1.9 on a 5-point scale (P < .001), mean elevation increased from 94° to 150°, mean external rotation increased from 22° to 57° (P < .001), larger lucent lines (≥ 1.5 mm) or change in glenoid position occurred around 19 components, and survivorship was 98% (95% confidence interval, 97%-100%) at 1 year and 98% (95% confidence interval, 95%-100%) at 5 years. No difference among head configurations was found for any of these outcomes.
Evolution of designs has provided options to more accurately re-create anatomy including changes caused by osteoarthritis. At the length of follow-up in this study, clinical outcomes, radiographic performance, and survivorship are equivalent when applying these humeral head variations, and no special complications have developed.
肱骨头部的变异是基于解剖学和生物力学优势而发展起来的；然而，这种扩大的假体库存的效果尚未在临床上得到研究。本研究旨在确定假体种类是否导致更好的结果，是否导致关节重建的相似结果，或是否产生任何意外的并发症。
对 160 例原发性全肩关节置换术进行了骨关节炎的治疗。患者接受了 52 个标准、60 个偏心和 48 个偏置肱骨头部。根据近正常运动范围与肩胛盂之间的互补关系，在手术中选择头部几何形状进行试戴。患者的随访时间为 2 年或直至再次手术（平均 4.7 年；范围，0.8-8.3 年）。
平均疼痛评分从 5 分制的 4.5 分降至 1.9 分（P <.001），平均抬高角度从 94°增至 150°，平均外旋角度从 22°增至 57°（P <.001），19 个组件周围出现较大的透光线（≥1.5 毫米）或肩胛盂位置变化，1 年时生存率为 98%（95%置信区间，97%-100%），5 年时生存率为 98%（95%置信区间，95%-100%）。在这些结果中，头部配置之间没有差异。
设计的演变提供了更准确地重建解剖结构的选择，包括由骨关节炎引起的变化。在本研究的随访长度内，当应用这些肱骨头部变化时，临床结果、影像学表现和生存率是等效的，并且没有出现特殊的并发症。
