Jo Seong Hwan, Kim Jung Youn, Cho Nam Su, Rhee Yong Girl
Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Hallym University Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2017 Jun;9(2):200-206. doi: 10.4055/cios.2017.9.2.200. Epub 2017 May 8.
To evaluate the clinical outcome of revision of primary shoulder replacement by using reverse total shoulder arthroplasty (RTSA).
Seven patients underwent revision RTSA with a mean follow-up of 22.1 months (range, 12 to 54 months). Their mean age at the time of operation was 75.5 years (range, 70 to 80 years). Assessments were performed on the preoperative and postoperative visual analogue scale (VAS) score, muscle strength, range of motion, University of California at Los Angeles (UCLA) score, Constant score, subjective satisfaction and the anteroposterior and axillary views of the glenohumeral joint. The primary operation was hemiarthroplasty in 5 patients, total shoulder replacement in 1 patient, and reverse shoulder arthroplasty in 1 patient. The cause of revision surgery was infection in 2 patients, humeral stem loosening in 2 patients, glenoid arthropathy in 2 patients, and glenoid loosening in 1 patient. The mean duration from primary operation to revision surgery was 52 months (range, 27 to 120 months).
The VAS score for pain during motion was improved from 7.3 preoperatively to 2.1 postoperatively ( = 0.03). There were increases in the mean active forward flexion (from 62.1° to 92.8°), abduction (from 70° to 87.1°), external rotation (from 44.2° to 47.4°), and internal rotation (from L5 to L4; > 0.05) postoperatively. Performance in activities of daily living improved ( > 0.05), except for lifting 10 lb above the shoulder (from 1.2 to 1.1; = 0.434). Overall, 5 of 7 patients were satisfied with the results of revision surgery. The mean Constant score improved from 44.8 preoperatively to 57.1 postoperatively ( = 0.018). The mean UCLA score improved from 12.8 preoperatively to 22.8 postoperatively ( = 0.027). In the postoperative radiological evaluation, no radiolucency was observed around the base plate or humeral stem.
Pain could be reduced after revision RTSA, but improvements in range of motion and function were difficult to achieve. We think that the patients' satisfaction was relatively high despite the low function score due to the preoperative severe pain and marked limitation of range of motion.
评估采用反式全肩关节置换术（RTSA）对初次肩关节置换进行翻修的临床效果。
7例患者接受了RTSA翻修术，平均随访22.1个月（范围12至54个月）。他们手术时的平均年龄为75.5岁（范围70至80岁）。在术前和术后对视觉模拟量表（VAS）评分、肌肉力量、活动范围、加州大学洛杉矶分校（UCLA）评分、Constant评分、主观满意度以及盂肱关节的前后位和腋位X线片进行评估。初次手术5例为半关节置换术，1例为全肩关节置换术，1例为反式肩关节置换术。翻修手术的原因是2例感染，2例肱骨干松动，2例关节盂病变，1例关节盂松动。初次手术至翻修手术的平均时间为52个月（范围27至120个月）。
活动时疼痛的VAS评分从术前的7.3改善至术后的2.1（P = 0.03）。术后平均主动前屈（从62.1°至92.8°）、外展（从70°至87.1°）、外旋（从44.2°至47.4°）和内旋（从L5至L4；P>0.05）均有所增加。日常生活活动能力有所改善（P>0.05），但肩部上方提起10磅重物的能力除外（从1.2至1.1；P = 0.434）。总体而言，7例患者中有5例对翻修手术结果满意。平均Constant评分从术前的44.8提高至术后的57.1（P = 0.018）。平均UCLA评分从术前的12.8提高至术后的22.8（P = 0.027）。在术后影像学评估中，未观察到基板或肱骨干周围有透光线。
RTSA翻修术后疼痛可减轻，但活动范围和功能的改善难以实现。我们认为，尽管由于术前严重疼痛和活动范围明显受限导致功能评分较低，但患者的满意度相对较高。
