Liu Joseph N, Garcia Grant H, Mahony Gregory, Wu Hao-Hua, Dines David M, Warren Russell F, Gulotta Lawrence V
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
J Shoulder Elbow Surg. 2016 Jun;25(6):920-6. doi: 10.1016/j.jse.2015.11.003. Epub 2016 Feb 4.
Traditionally, fewer postoperative sport restrictions are imposed on hemiarthroplasty (HHA) patients on than reverse total shoulder arthroplasty (RTSA) patients. However, functional outcomes have been shown to be superior in RTSA. No direct comparison of RTSA vs HHA has been done on rates of return to sports in patients with glenohumeral arthritis and rotator cuff dysfunction, proximal humeral fractures, or rheumatoid arthritis.
This is a retrospective review of consecutive RTSA and HHA patients collected from our institution's shoulder arthroplasty registry. All patients playing sports preoperatively with minimum 1-year follow-up were included. Final follow-up included an additional patient-reported questionnaire with questions regarding physical fitness and sport activities.
The study included 102 RTSA and 71 HHA patients. Average age at surgery was 72.3 years for RTSA compared with 65.6 years for HHA (P < .001). Patients undergoing RTSA had improved visual analog scale scores compared with HHA (-5.6 vs -4.2, P = .007), returned to sports after RTSA at a significantly higher rate (85.9% vs 66.7%, P = .02), and were more likely to be satisfied with their ability to play sports (P = .013). HHA patients were also more likely to have postoperative complaints than RTSA patients (63% vs 29%, P < .0001). No sports-related complications occurred. Female sex, age <70 years, surgery on the dominant extremity, and a preoperative diagnosis of arthritis with rotator cuff dysfunction predicted a higher likelihood of return to sports for patients undergoing RTSA compared with HHA.
Despite traditional sport restrictions placed on RTSA, patients undergoing RTSA can return to sports at rates higher than those undergoing HHA, with fewer postoperative complaints.
传统上，半关节置换术（HHA）患者术后的运动限制比反向全肩关节置换术（RTSA）患者少。然而，研究表明RTSA的功能结局更优。对于患有盂肱关节炎和肩袖功能障碍、肱骨近端骨折或类风湿关节炎的患者，尚未对RTSA与HHA的运动恢复率进行直接比较。
这是一项对从我们机构的肩关节置换登记处收集的连续RTSA和HHA患者进行的回顾性研究。纳入所有术前进行运动且随访至少1年的患者。最终随访包括一份额外的患者报告问卷，其中包含有关身体健康和体育活动的问题。
该研究纳入了102例RTSA患者和71例HHA患者。RTSA患者的平均手术年龄为72.3岁，而HHA患者为65.6岁（P <.001）。与HHA患者相比，接受RTSA的患者视觉模拟量表评分有所改善（-5.6对-4.2，P =.007），RTSA后恢复运动的比例显著更高（85.9%对66.7%，P =.02），并且对其运动能力更有可能感到满意（P =.013）。HHA患者术后出现不适的可能性也高于RTSA患者（63%对29%，P <.0001）。未发生与运动相关的并发症。与HHA相比，女性、年龄<70岁、优势肢体手术以及术前诊断为关节炎伴肩袖功能障碍预测接受RTSA的患者恢复运动的可能性更高。
尽管RTSA有传统的运动限制，但接受RTSA的患者恢复运动的比例高于接受HHA的患者，且术后不适更少。
