McFarland Edward G, Huri Gazi, Hyun Yoon Suk, Petersen Steve A, Srikumaran Uma
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
J Bone Joint Surg Am. 2016 Nov 2;98(21):1801-1807. doi: 10.2106/JBJS.15.01181.
Treating shoulders with osteoarthritis, an intact rotator cuff, and substantial glenoid bone loss is challenging. One option is reaming the glenoid flat and inserting a reverse prosthesis. This study reports the subjective, objective, and radiographic results of reverse total shoulder arthroplasty (RTSA) in this population.
We retrospectively reviewed 42 consecutive patients (23 women; mean age, 71 years [range, 53 to 89 years]) with primary glenohumeral osteoarthritis, intact rotator cuffs, and Walch type-A2 (n = 19), B2 (n = 5), or C glenoids (n = 18) who had undergone a total of 42 RTSAs with glenoid reaming without bone-grafting between 2008 and 2013 (mean follow-up, 36 months [range, 24 to 66 months]). All patients were evaluated before and after surgery subjectively (using a visual analog scale for pain and 5 shoulder-specific outcome instruments), objectively (with goniometric examination of shoulder range of motion), and radiographically (to assess baseplate loosening and degree of scapular notching).
One baseplate (2%) failed, requiring revision surgery. There were no other signs of baseplate loosening in any patient at the last follow-up. Preoperatively to postoperatively, pain improved significantly (p < 0.001), as did all patient-reported outcome measures and the following range-of-motion parameters (p ≤ 0.001): active abduction, active flexion, and active external rotation with the arm elevated 90°. Eight (19%) of the patients had notching.
RTSA without bone-grafting and with medialization of the baseplate in patients with osteoarthritis and severe glenoid bone loss resulted in significant improvement in pain and function with reliable short-term implant survivorship and may be a good alternative to anatomical TSA. Longer follow-up is needed to determine the relative advantages and disadvantages. This was an "off-label" indication for this device.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
治疗患有骨关节炎、肩袖完整且存在大量关节盂骨质流失的肩部疾病具有挑战性。一种选择是将关节盂打磨平整并植入反向假体。本研究报告了该人群中反向全肩关节置换术（RTSA）的主观、客观和影像学结果。
我们回顾性分析了2008年至2013年间连续42例（23例女性；平均年龄71岁[范围53至89岁]）原发性盂肱关节骨关节炎、肩袖完整且关节盂为Walch A2型（n = 19）、B2型（n = 5）或C型（n = 18）的患者，这些患者共接受了42例未进行植骨的关节盂扩孔RTSA手术（平均随访36个月[范围24至66个月]）。所有患者在手术前后均接受主观评估（使用视觉模拟疼痛量表和5种肩部特异性结局工具）、客观评估（通过测角仪检查肩部活动范围）以及影像学评估（以评估基板松动和肩胛切迹程度）。
1个基板（2%）出现故障，需要翻修手术。在最后一次随访时，没有其他患者出现基板松动的迹象。术前至术后，疼痛显著改善（p < 0.001），所有患者报告的结局指标以及以下活动范围参数也显著改善（p ≤ 0.001）：主动外展、主动屈曲以及手臂抬高90°时的主动外旋。8例（19%）患者出现切迹。
对于患有骨关节炎和严重关节盂骨质流失的患者，不进行植骨且将基板向内侧移位的RTSA手术可显著改善疼痛和功能，短期植入物存活率可靠，可能是解剖型全肩关节置换术的良好替代方案。需要更长时间的随访来确定其相对优势和劣势。这是该器械的“非标签”适应证。
治疗水平IV。有关证据水平的完整描述，请参阅作者指南。
