Alentorn-Geli Eduard, Wanderman Nathan R, Assenmacher Andrew T, Sperling John W, Cofield Robert H, Sánchez-Sotelo Joaquín
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018789527. doi: 10.1177/2309499018789527.
Revision of failed anatomic total shoulder arthroplasty or hemiarthroplasty is a challenging procedure. Restoring adequate soft tissue balance in the revision setting can be particularly problematic. When persistent posterior instability is encountered in the revision setting, options include changing component position or size, posterior capsular plication (PCP), or conversion to a reverse arthroplasty. The purpose of this study was to report the clinical and radiographic outcomes, complications, and reoperations of PCP performed in the setting of revision anatomic shoulder arthroplasty.
Between 1975 and 2013, 15 patients (16 shoulders) had PCP during revision anatomic shoulder arthroplasty. Indications for revision arthroplasty included posterior instability in 15, glenoid loosening in 3, polyethylene wear in 2, and glenoid erosion in 1 shoulder. The mean (standard deviation (SD)) age was 60.1 (12.6) years, and the median (range) follow-up was 68 (2-228) months. A retrospective chart review was conducted to obtain all data.
At the last follow-up, nine shoulders (56%) had absence of posterior radiographic subluxation. Five (31%) cases underwent reoperation due to persistent posterior instability. Complications were observed in seven (44%) cases. Complete pain relief was achieved in four (25%) shoulders. The mean (SD) postoperative forward flexion, external rotation, and the American Shoulder and Elbow Surgeons score were 110° (41°), 40° (29°), and 62.1 (21.9), respectively. Results were excellent in two (13%), satisfactory in seven (44%), and unsatisfactory in seven (44%) shoulders.
PCP to correct posterior instability during revision anatomic shoulder arthroplasty had an unacceptably high failure rate. In these circumstances, consideration should instead be given to conversion to a reverse shoulder arthroplasty.
失败的解剖型全肩关节置换术或半肩关节置换术的翻修是一项具有挑战性的手术。在翻修手术中恢复足够的软组织平衡可能特别困难。当在翻修手术中遇到持续性后向不稳定时，选择包括改变假体位置或尺寸、后方关节囊折叠术（PCP）或转换为反置式人工关节置换术。本研究的目的是报告在解剖型肩关节置换术翻修中进行PCP的临床和影像学结果、并发症及再次手术情况。
1975年至2013年间，15例患者（16个肩关节）在解剖型肩关节置换术翻修期间接受了PCP。翻修关节成形术的指征包括15例后向不稳定、3例肩胛盂松动、2例聚乙烯磨损以及1个肩关节的肩胛盂侵蚀。平均（标准差）年龄为60.1（12.6）岁，中位（范围）随访时间为68（2 - 228）个月。通过回顾病历获取所有数据。
在最后一次随访时，9个肩关节（56%）影像学上无后向半脱位。5例（31%）因持续性后向不稳定接受了再次手术。7例（44%）出现并发症。4个肩关节（25%）实现了完全疼痛缓解。术后平均（标准差）前屈、外旋以及美国肩肘外科医师评分分别为110°（41°）、40°（29°）和62.1（21.9）。2个肩关节（13%）结果为优，7个（44%）为良，7个（44%）为差。
在解剖型肩关节置换术翻修中采用PCP纠正后向不稳定的失败率高得令人难以接受。在这种情况下，应考虑转换为反置式肩关节置换术。
