Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
J Shoulder Elbow Surg. 2013 Sep;22(9):1221-7. doi: 10.1016/j.jse.2012.12.034. Epub 2013 Mar 6.
Glenoid component loosening is thought to be a major cause of failure. This study assesses radiographic and clinical failure in shoulder arthroplasty, identifying factors predictive of loosening.
Three-hundred two shoulder arthroplasties were implanted utilizing a cemented, keeled glenoid component, mean clinical follow-up 8.6 years. One-hundred fifty one shoulders had preoperative, early postoperative, and most recent radiographs, mean radiographic follow-up 8.0 years, minimum 4 years or less if revision was performed (2 cases).
Fifty-two of 151 glenoid components (34%) showed a shift in position or a complete lucent line ≥1.5 mm. Four humeral components (3%) shifted or showed a 2-mm lucency in 3 zones. Component survival (Kaplan-Meier) free from radiographic failure at 5 and 10 years were 99% (95% CI) (98-100%) and 67% (95% CI) (58-78%). Glenoid components with lines at the keel on initial radiographs were at risk for radiographic failure, hazard ratio 4.6 95% CI 1.2-17.2, P = .02. No associations were found between radiographic survival and age, gender, diagnosis, glenoid erosion, and preoperative or early subluxation. Late subluxation superiorly was associated with the glenoid at risk for radiographic failure (P = .006). Glenoid component survivals free from revision at 5 and 10 years for the 302 shoulders were 99% (95% CI) (97-100%) and 93% (95% CI) (90-97%).
Glenoid radiolucencies are seldom seen early, except beneath the faceplate. Glenoid radiolucencies develop, with notable changes 5 or more years following surgery. Humeral components seldom loosen. Revision rates remain low. The high frequency of late radiographic changes dictates the need for innovation.
肩盂组件松动被认为是失败的主要原因。本研究评估了肩关节置换术后的影像学和临床失败情况，确定了与松动相关的预测因素。
使用骨水泥固定的有槽肩盂组件植入 302 例肩关节置换术，平均临床随访 8.6 年。151 例患者术前、术后早期和最近有 X 线片，平均影像学随访 8.0 年，若进行翻修则最短随访时间为 4 年（2 例）。
151 例肩盂组件中，52 例（34%）出现位置改变或完全透亮线≥1.5mm。4 例肱骨头组件（3%）发生移位或在 3 个区域出现 2mm 透亮线。5 年和 10 年时，无影像学失败的组件生存率（Kaplan-Meier）分别为 99%（95%可信区间）（98-100%）和 67%（95%可信区间）（58-78%）。初始 X 线片上肩盂组件槽口有透亮线的患者发生影像学失败的风险较高，危险比为 4.6（95%可信区间 1.2-17.2，P=0.02）。未发现影像学生存率与年龄、性别、诊断、肩盂骨侵蚀以及术前或早期半脱位之间存在关联。晚期向上半脱位与有影像学失败风险的肩盂有关（P=0.006）。302 例患者无翻修的 5 年和 10 年肩盂组件生存率分别为 99%（95%可信区间）（97-100%）和 93%（95%可信区间）（90-97%）。
除了在假体下面，早期很少见到肩盂透亮线。肩盂透亮线在术后 5 年或更长时间后才出现明显变化。肱骨头组件很少松动。翻修率仍然较低。晚期影像学变化的高频率要求进行创新。
