Florida Orthopaedic Institute, Tampa, FL, USA.
Foundation for Orthopaedic Research and Education, Tampa, FL, USA.
J Shoulder Elbow Surg. 2020 Jul;29(7S):S149-S156. doi: 10.1016/j.jse.2019.08.019. Epub 2019 Nov 6.
The purposes of this study were to evaluate patient outcomes after revision of hemiarthroplasty to reverse shoulder arthroplasty (RSA) based on initial pathology, to determine the re-revision rate, and to identify characteristics that may predict subsequent re-revision.
A total of 207 shoulder hemiarthroplasty, bipolar prosthesis, and humeral resurfacing cases revised to RSA between January 2004 and January 2017 were reviewed. Outcome measures included shoulder motion and American Shoulder and Elbow Surgeons and Simple Shoulder Test (SST) scores. Sixteen RSAs underwent re-revision. A case-control study with each revised RSA matched to 4 controls based on age, sex, and minimum 2-year follow-up was performed to evaluate for factors predicting re-revision.
The mean time from initial hemiarthroplasty to RSA was 3.6 years (range, 0.1-20 years). There were 114 patients with a minimum of 2 years' follow-up (mean, 57 months; range, 24-144 months). The most common initial diagnoses for hemiarthroplasty were fracture (n = 72), cuff tear arthropathy (CTA) (n = 22), and osteoarthritis (OA) (n = 20). Overall mean scores and range-of-motion values were as follows: American Shoulder and Elbow Surgeons score, 59 (95% confidence interval [CI], 54-64); SST score, 4 (95% CI, 4-5); forward flexion, 106° (95% CI, 96°-116°); and abduction, 95° (95% CI, 85°-105°). Compared with fracture cases, CTA cases had better forward flexion (P = .01) and abduction (P = .006) and OA cases had better SST scores (P = .02) and abduction (P = .04). The re-revision rate was 7.7% at a mean of 31 months (range, 0-116 months), with the most common diagnosis being fracture (10 of 16 cases). Humeral loosening (8 of 16 cases) was the most common failure mechanism, and larger glenosphere sizes were more likely to be revised.
Functional outcome scores of hemiarthroplasty cases revised to RSA were better for patients with OA than for patients with CTA or fracture. Cases of hemiarthroplasty for fracture had decreased motion after revision to RSA compared with CTA and OA. Humeral loosening was the most common failure mechanism.
本研究旨在评估初次病因、翻修后再翻修率及识别可能预测再次翻修的特征，从而评估初次行人工半肩关节置换术（Hemiarthroplasty，HA）翻修为反式肩关节置换术（Reverse Shoulder Arthroplasty，RSA）患者的治疗效果。
2004 年 1 月至 2017 年 1 月，对 207 例 HA、双极假体和肱骨表面置换翻修为 RSA 的病例进行回顾性研究。评估指标包括肩部活动度、美国肩肘外科医生协会评分（American Shoulder and Elbow Surgeons，ASES）和简易肩测试评分（Simple Shoulder Test，SST）。16 例 RSA 行再次翻修。通过年龄、性别和至少 2 年的随访匹配每例再次翻修 RSA 的 4 例对照，进行病例对照研究，以评估预测再次翻修的因素。
初次 HA 至 RSA 的平均时间为 3.6 年（0.1-20 年）。114 例患者的随访时间至少为 2 年（平均 57 个月，24-144 个月）。初次 HA 的最常见诊断为骨折（n=72）、肩袖撕裂性关节炎（Cuff Tear Arthropathy，CTA）（n=22）和骨关节炎（Osteoarthritis，OA）（n=20）。总体平均评分和活动范围值如下：ASES 评分 59（95%置信区间[CI]，54-64）；SST 评分 4（95%CI，4-5）；前屈 106°（95%CI，96°-116°）；外展 95°（95%CI，85°-105°）。与骨折病例相比，CTA 病例的前屈和外展活动度更好（P=.01 和 P=.006），OA 病例的 SST 评分和外展活动度更好（P=.02 和 P=.04）。再次翻修率为 7.7%，平均时间为 31 个月（0-116 个月），最常见的诊断为骨折（16 例中有 10 例）。肱骨头松动（16 例中有 8 例）是最常见的失败机制，较大的肱骨头尺寸更可能被翻修。
与 CTA 或骨折相比，OA 患者行 RSA 翻修的 HA 病例的功能评分更好。与 CTA 和 OA 相比，行 RSA 翻修的骨折患者的活动度降低。肱骨头松动是最常见的失败机制。
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