Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
J Shoulder Elbow Surg. 2019 Mar;28(3):483-495. doi: 10.1016/j.jse.2018.08.020. Epub 2018 Nov 2.
Cuff tear arthropathy is commonly managed with a reverse total shoulder arthroplasty (RTSA). A humeral hemiarthroplasty with an extended humeral head may provide a less invasive alternative for selected patients with cuff tear arthropathy if the shoulder has preserved active elevation. Because evidence regarding this procedure is limited, we investigated its safety and efficacy in treating selected patients with cuff tear arthropathy.
We analyzed the preoperative characteristics, surgical findings, and clinical outcomes for patients selected for extended head hemiarthroplasty.
For 42 patients with 2-year follow-up, there were no complications or revisions. The Simple Shoulder Test score improved from a median of 3.0 to 8.0 (P < .001). The median percentage of maximal possible improvement was 50% (P < .001). The percentage of patients able to perform each of the functions of the Simple Shoulder Test was significantly improved; for example, the ability to sleep comfortably increased from 19% to 71%, and the ability to place a coin on the shelf at shoulder level increased from 38% to 86% (P < .001).
There are circumstances in which RTSA is clearly the preferred procedure for cuff tear arthropathy, including pseudoparalysis, anterosuperior escape, and glenohumeral instability; however, in shoulders with preserved active motion and stability of the humeral head provided by an intact coracoacromial arch, the extended head humeral arthroplasty can enable selected patients to realize improved comfort and function without the potential risks of RTSA. Extended humeral head hemiarthroplasty can provide a safe and effective alternative for the management of selected patients with rotator cuff tear arthropathy and preserved active motion.
肩袖撕裂性关节炎通常采用反式全肩关节置换术（RTSA）治疗。对于肩袖撕裂性关节炎患者，如果肩关节有保留的主动抬高功能，肱骨头延长半肩关节置换术可能是一种侵袭性较小的替代方法。由于该手术的证据有限，我们研究了其治疗特定肩袖撕裂性关节炎患者的安全性和疗效。
我们分析了接受延长头半肩关节置换术的患者的术前特征、手术发现和临床结果。
在 42 例具有 2 年随访的患者中，无并发症或翻修。简易肩测试评分从中位数 3.0 提高到 8.0（P<0.001）。最大可能改善的中位数百分比为 50%（P<0.001）。能够执行简易肩测试各项功能的患者比例显著提高；例如，舒适睡眠的能力从 19%提高到 71%，将硬币放在肩部水平搁板上的能力从 38%提高到 86%（P<0.001）。
在某些情况下，RTSA 显然是肩袖撕裂性关节炎的首选手术方法，包括假性瘫痪、前上逃逸和肩盂肱不稳；然而，在保留主动运动和由完整肩峰下弓提供的肱骨头稳定性的肩关节中，延长头肱骨头关节置换术可以使选定的患者在没有 RTSA 潜在风险的情况下提高舒适度和功能。延长头肱骨头半肩关节置换术可为保留主动运动的特定肩袖撕裂性关节炎患者的管理提供一种安全有效的替代方法。
