Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2014 May;23(5):737-44. doi: 10.1016/j.jse.2013.08.015. Epub 2013 Nov 1.
Although instability can occur after reverse total shoulder arthroplasty (RTSA), the risk factors, the treatment, and ultimate fate of the implant in these patients remains poorly understood.
Demographics, acute treatment, and the need for revision were evaluated in all patients with RTSAs who sustained a subsequent dislocation within the first 3 months. Standardized outcome scores were collected preoperatively and at the final follow-up.
Atraumatic instability occurred in 11 patients (incidence, 2.9%) treated with RTSA early (before 3 months postsurgery). The mean time to dislocation was 3.4 weeks. These patients tended to be previously operated-on (64%), male (82%), overweight (mean body mass index (BMI) of 32.2 kg/m(2), with 82% having a BMI ≥30 kg/m(2)), and without a satisfactory subscapularis repair at initial RTSA (64%). Initial treatment included closed reduction in 9 patients, open reduction in 1, and open reduction with a thicker polyethylene insert in 1. Four experienced recurrent instability requiring a thicker polyethylene insert. Two additional patients were converted to hemiarthroplasty due to persistent instability. Visual analog pain scores (P = .014) and American Shoulder and Elbow Surgeons scores (P = .018) were significantly improved. Simple Shoulder Test scores trended towards improvement (P = .073).
Early dislocations of the RTSA prosthesis were uncommon. The most common associated factors were a BMI >30 kg/m(2), male gender, subscapularis deficiency, and previous surgery; in these patients, we now use an abduction orthosis. Closed reduction alone was successful in 4 of the 9 closed reductions (44%). Five of 11 RTSAs (45%) required polyethylene exchange. The RTSA was retained in 82%, 36% with the original implant.
虽然反式全肩关节置换术后（RTSA）可能会发生不稳定，但这些患者的植入物的风险因素、治疗方法和最终结局仍知之甚少。
评估所有 RTSA 患者中在术后 3 个月内发生后续脱位的患者的人口统计学资料、急性治疗和修订需求。在术前和最后随访时收集了标准化的结果评分。
11 例（发生率 2.9%）RTSA 后发生无创伤性不稳定（发生在术后 3 个月内）。脱位的平均时间为 3.4 周。这些患者往往之前接受过手术（64%）、男性（82%）、超重（平均 BMI 为 32.2kg/m²，82%的 BMI≥30kg/m²），且初次 RTSA 时没有满意的肩胛下肌修复（64%）。初始治疗包括 9 例闭合复位、1 例切开复位和 1 例切开复位伴更厚的聚乙烯插入物。4 例因反复不稳定而需要更换更厚的聚乙烯插入物。由于持续不稳定，另外 2 例患者转换为半肩置换术。视觉模拟疼痛评分（P=.014）和美国肩肘外科医生评分（P=.018）显著改善。简单肩部测试评分呈改善趋势（P=.073）。
RTSA 假体的早期脱位并不常见。最常见的相关因素是 BMI>30kg/m²、男性、肩胛下肌缺失和既往手术；在这些患者中，我们现在使用外展支架。9 例闭合复位中的 4 例（44%）仅闭合复位成功。11 例 RTSA 中有 5 例（45%）需要更换聚乙烯。82%的 RTSA 保留，36%的 RTSA 保留原始植入物。
