Hussey Michael M, Steen Brandon M, Cusick Michael C, Cox Jacob L, Marberry Scott T, Simon Peter, Cottrell Benjamin J, Santoni Brandon G, Frankle Mark A
Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA.
Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, Tampa, FL, USA.
J Shoulder Elbow Surg. 2015 May;24(5):682-90. doi: 10.1016/j.jse.2014.09.043. Epub 2014 Dec 3.
Despite the success of total shoulder arthroplasty (TSA), concerns remain about the longevity of the implant, in particular, glenoid component survivorship. The purpose of this study was to determine whether preoperative glenoid wear patterns affect clinical outcomes and value in patients undergoing TSA.
A comparative cohort study was conducted of 309 patients with a total of 344 TSA procedures, performed for primary glenohumeral osteoarthritis. Computed tomography scans were obtained in all patients, with preoperative glenoid wear pattern characterized as either concentric (n = 196; follow-up time, 49.2 months) or eccentric (n = 148; follow-up time, 52.3 months) according to a modified Levine classification. A clinical, radiographic, and economic assessment was performed between the 2 wear patterns.
There was no significant difference in American Shoulder and Elbow Surgeons (ASES) score in the concentric group (80.8 ± 20.8) compared with the eccentric group (77.6 ± 21.2) at final follow-up (P = .159). Range of motion and final visual analog scale for pain score were similar between the 2 groups. Radiographic evidence of gross glenoid loosening was significantly lower in the concentric group [11 of 195 (5.6%)] compared with the eccentric group [18 of 147 (12.2%)] (P = .030). Revision rates were similar between the concentric group [4 of 195 (2.0%)] and the eccentric group [3 of 147 (2.0%)]. A value assessment also showed no significant difference between the concentric and eccentric groups [concentric 26.1 vs. eccentric 25.5 (ΔASES score/$10,000 hospital cost) (P = .479)].
Similar clinical results and value can be expected with both concentric and eccentric glenoid wear patterns in TSA. Concerns arise, however, as the eccentric group demonstrated a more than 2-fold increased rate of glenoid component loosening compared with the concentric group.
尽管全肩关节置换术（TSA）取得了成功，但人们仍对植入物的使用寿命，尤其是肩胛盂组件的生存率存在担忧。本研究的目的是确定术前肩胛盂磨损模式是否会影响接受TSA患者的临床结果和价值。
对309例患者进行了一项比较队列研究，共进行了344例TSA手术，用于治疗原发性盂肱关节炎。所有患者均进行了计算机断层扫描，根据改良的Levine分类，术前肩胛盂磨损模式分为同心型（n = 196；随访时间49.2个月）或偏心型（n = 148；随访时间52.3个月）。对两种磨损模式进行了临床、影像学和经济学评估。
在末次随访时，同心组（80.8±20.8）与偏心组（77.6±21.2）的美国肩肘外科医师（ASES）评分无显著差异（P = 0.159）。两组之间的活动范围和最终疼痛视觉模拟评分相似。同心组[195例中的11例（5.6%）]与偏心组[147例中的18例（12.2%）]相比，肩胛盂严重松动的影像学证据显著更低（P = 0.030）。同心组[195例中的4例（2.0%）]和偏心组[147例中的3例（2.0%）]的翻修率相似。价值评估也显示同心组和偏心组之间无显著差异[同心组26.1对偏心组25.5（ASES评分变化/$10,000医院费用）（P = 0.479）]。
TSA中同心型和偏心型肩胛盂磨损模式均可预期获得相似的临床结果和价值。然而，令人担忧的是，偏心组肩胛盂组件松动率比同心组增加了两倍多。
