IULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
Hôpitaux Universitaires de Genève, Geneva, Switzerland.
J Shoulder Elbow Surg. 2020 Mar;29(3):541-549. doi: 10.1016/j.jse.2019.07.034. Epub 2019 Oct 6.
Our aim was to analyze the epidemiology, etiologies, and revision options for failed shoulder arthroplasty from 2 tertiary centers.
From 1993 to 2013, 542 failed arthroplasties were revised in 540 patients (65% women): 224 hemiarthroplasties (HAs, 41%), 237 anatomic total shoulder arthroplasties (TSAs, 44%) and 81 reverse total arthroplasties (RSAs, 15%). Data about patients, pathology, and reintervention procedures, as well as intraoperative data, were analyzed from our 2 local registries that prospectively captured all the revision procedures. Patients had an average follow-up period of 8.7 years.
The revision rate was 12.7% for HAs, 6.7% for TSAs, and 3.9% for RSAs. HAs were revised earlier (33 ± 40 months) than RSAs (47 ± 150 months) and TSAs (69 ± 61 months). Glenoid failure was a major cause of reintervention: erosion in HAs (29%) or loosening in TSAs (37%) and RSAs (24%). Instability was another major cause of reintervention: 32% in RSAs, 20% in TSAs, and 13% in HAs. Humeral implant loosening led to revision in 10% of RSAs, 6% of HAs, and 6% of TSAs. Multiple reinterventions were required in 21% of patients, mainly for instability (26%) and/or infection (25%). The final implant was an RSA in 48%, especially when associated with cuff insufficiency, instability, and/or bone loss. Final reimplantation was possible in 90% of cases, with the remaining 10% treated with a resection or spacer.
Glenoid failure and instability are the most common causes of revision. Soft-tissue insufficiency and/or infection results in multiple revisions. Surgeons must recognize all complications so that they can be addressed at the first revision operation and avoid further reinterventions. RSA was the most common final revision implant.
本研究旨在分析两家三级医疗机构中 542 例失败肩关节置换的流行病学、病因学和翻修选择。
1993 年至 2013 年，540 例患者（65%为女性）中的 542 例失败关节置换接受了翻修：224 例半肩关节置换（HAs，41%）、237 例解剖全肩关节置换（TSAs，44%）和 81 例反式全肩关节置换（RSAs，15%）。我们从两家本地注册处分析了患者、病理学和再次手术程序以及术中数据，这些注册处前瞻性地捕获了所有翻修手术。患者的平均随访时间为 8.7 年。
HAs 的翻修率为 12.7%，TSAs 为 6.7%，RSAs 为 3.9%。HAs 的翻修时间较早（33±40 个月），而 RSA（47±150 个月）和 TSA（69±61 个月）则较晚。盂肱关节失败是再次手术干预的主要原因：HAs 为侵蚀（29%）或 TSA（37%）和 RSA（24%）的松动。不稳定是再次手术干预的另一个主要原因：RSAs 为 32%，TSAs 为 20%，HAs 为 13%。10%的 RSA、6%的 HAs 和 6%的 TSA 因肱骨干假体松动而需要翻修。21%的患者需要多次手术干预，主要是由于不稳定（26%）和/或感染（25%）。最终植入物为 RSA 占 48%，尤其是当伴有肩袖缺损、不稳定和/或骨量丢失时。90%的病例可以进行最终再植入，其余 10%的病例采用切除或间隔器治疗。
盂肱关节失败和不稳定是翻修的最常见原因。软组织不足和/或感染导致多次翻修。外科医生必须认识到所有的并发症，以便在第一次翻修手术中解决，并避免进一步的干预。RSA 是最常见的最终翻修植入物。
