1Palm Beach Orthopaedic Institute, Palm Beach Gardens, Florida 2Medical University of South Carolina, Charleston, South Carolina 3Stanford University, Stanford, California 4Bordeaux-Mérignac Clinic, Mérignac, France 5Department of Orthopaedics, University of Florida, Gainesville, Florida 6Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY 7Exactech, Gainesville, Florida.
J Bone Joint Surg Am. 2017 Nov 1;99(21):1801-1811. doi: 10.2106/JBJS.16.01387.
This study quantifies the rate of improvement after anatomic and reverse total shoulder arthroplasty; a better understanding of the rate of improvement associated with each prosthesis type may better establish patient expectations for recovery.
Prospectively collected data on 1,183 patients who underwent either anatomic total shoulder arthroplasty (n = 505) or reverse total shoulder arthroplasty (n = 678) were collected. The Simple Shoulder Test (SST), University of California at Los Angeles (UCLA) Shoulder, American Shoulder and Elbow Surgeons (ASES), Constant, and Shoulder Pain and Disability Index (SPADI) scores, along with range of motion, were recorded preoperatively and at routine postoperative time points. All included patients had a minimum follow-up of 2 years. The rate of improvement of these outcome measures was quantified for patients who underwent anatomic total shoulder arthroplasty and those who underwent reverse total shoulder arthroplasty to compare recovery over time.
In this study, 3,587 visits by 1,183 patients were analyzed and several differences between prosthesis types were noted. Patients who underwent reverse total shoulder arthroplasty experienced larger improvements in the Constant score and active forward flexion, and patients who underwent anatomic total shoulder arthroplasty demonstrated better improvement in external rotation compared with patients who underwent reverse total shoulder arthroplasty at nearly all time points. By 72 months, improvement in flexion and abduction decreased for each prosthesis type, but in particular for reverse total shoulder arthroplasty. Full improvement was achieved by 24 months, although the majority of improvement was achieved in the first 6 months, with all 5 scoring metrics following a similar rate of improvement. The ASES, SPADI, and UCLA Shoulder scores closely mirrored each other in the magnitude of improvement, and the SST score demonstrated the largest improvement and the Constant score demonstrated the smallest improvement for both anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty.
Both anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty reliably result in improved patient outcomes. However, anatomic total shoulder arthroplasty more reliably improves range of motion, particularly external rotation. Most improvement occurs by 6 months, with some additional improvement up to 2 years for both anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty. Although the indications for anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty are substantially different, in addition to the biomechanical differences, the improvement in outcome scores over time can be expected to be very similar. This study is helpful to patients and health-care providers to establish expectations regarding the rate of recovery after total shoulder arthroplasty.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究量化了解剖型和反式全肩关节置换术后的改善率；更好地了解与每种假体类型相关的改善率，可能会更好地确定患者对恢复的预期。
前瞻性收集了 1183 例接受解剖型全肩关节置换术（n=505）或反式全肩关节置换术（n=678）患者的数据。术前及常规术后时间点记录简易肩部测试（SST）、加州大学洛杉矶分校（UCLA）肩部评分、美国肩肘外科医师协会（ASES）评分、Constant 评分和肩痛与残疾指数（SPADI），以及活动范围。所有纳入的患者均随访至少 2 年。为了比较随时间的恢复情况，量化了接受解剖型全肩关节置换术和反式全肩关节置换术患者的这些结局指标的改善率。
在这项研究中，分析了 1183 名患者的 3587 次就诊，发现了两种假体类型之间的几个差异。接受反式全肩关节置换术的患者在 Constant 评分和主动前屈方面的改善幅度较大，而接受解剖型全肩关节置换术的患者在几乎所有时间点的外旋改善方面均优于接受反式全肩关节置换术的患者。72 个月时，每种假体类型的屈曲和外展改善均下降，但反式全肩关节置换术尤其明显。24 个月时即达到完全改善，尽管大多数改善发生在第 6 个月内，所有 5 项评分指标的改善率相似。ASES、SPADI 和 UCLA 肩部评分在改善幅度上相互一致，SST 评分在解剖型全肩关节置换术和反式全肩关节置换术中的改善幅度最大，Constant 评分的改善幅度最小。
解剖型全肩关节置换术和反式全肩关节置换术均能可靠地改善患者的结局。然而，解剖型全肩关节置换术更可靠地改善了运动范围，尤其是外旋。大多数改善发生在 6 个月内，解剖型全肩关节置换术和反式全肩关节置换术的改善均持续到 2 年。尽管解剖型全肩关节置换术和反式全肩关节置换术的适应证有很大不同，除了生物力学差异外，随着时间的推移，结局评分的改善也可以预期非常相似。本研究有助于患者和医疗保健提供者建立对全肩关节置换术后恢复速度的预期。
治疗学 3 级。请参阅《作者须知》，以获取完整的证据分级描述。
