Clinic for Orthopedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, Universität Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
Arch Orthop Trauma Surg. 2020 Nov;140(11):1587-1594. doi: 10.1007/s00402-019-03328-y. Epub 2020 Jan 2.
The degree of preoperative osteoarthritis has been shown to influence the postoperative outcome and the patients' satisfaction rate in hip and knee joint replacement surgery. However, no corresponding information is available for total shoulder arthroplasty (TSA). We therefore set out to evaluate the influence of preoperatively measured end-stage osteoarthritis on the postoperative clinical outcome of TSA.
A retrospective analysis of 103 anatomic total shoulder replacements (96 patients) was performed. Patients were evaluated radiologically with X-rays in two planes and clinically using the Constant and Murley score (CS) and the self-reported satisfaction with the result. The degree of osteoarthritis was radiographically analyzed with the aid of the classifications according to Kellgren/Lawrence, Gerber, Guyette, and Allain and according to whether complete narrowing of the glenohumeral joint was present or not [bone-on-bone contact (BOB) or no bone-on-bone contact (No BOB)].
The clinical results of TSA did not differ significantly among the various stages of osteoarthritis in any of the classifications (p > 0.05). The CS was significantly higher postoperatively for both the BOB and the No BOB group (p < 0.0001). Patients with BOB had a significantly lower CS preoperatively than patients with No BOB (p = 0.0172). In addition, the preoperative pain level was significantly higher in patients with BOB (p = 0.014). Postoperatively, no significant difference in CS (p = 0.6738) was found between the BOB group and the No BOB group. The mean improvement in CS was not statistically significant (p = 0.2218).
In contrast to hip and knee joint replacement procedures, a milder grade of osteoarthritis does not adversely influence the functional result or subjective satisfaction rate after TSA. The degree of osteoarthritis on conventional X-rays has no bearing on the postoperative clinical outcome. Therefore, the decision on when to carry out anatomic total shoulder arthroplasty should depend on the patient's pain level and loss of quality of life.
术前骨关节炎的严重程度已被证明会影响髋关节和膝关节置换手术后的结果和患者的满意度。然而，对于全肩关节置换术（TSA），尚无相应信息。因此，我们评估了术前测量的终末期骨关节炎对 TSA 术后临床结果的影响。
对 103 例解剖型全肩关节置换（96 例患者）进行回顾性分析。患者通过 X 线在两个平面上进行影像学评估，并使用Constant 和 Murley 评分（CS）和自我报告的对结果的满意度进行临床评估。使用根据 Kellgren/Lawrence、Gerber、Guyette 和 Allain 的分类以及是否存在全肩关节间隙完全狭窄[骨对骨接触（BOB）或无骨对骨接触（No BOB）]对骨关节炎的严重程度进行放射学分析。
在任何分类中，TSA 的临床结果在骨关节炎的各个阶段之间均无显著差异（p>0.05）。在 BOB 和 No BOB 组中，术后 CS 均显著升高（p<0.0001）。与 No BOB 组相比，BOB 组患者术前 CS 明显较低（p=0.0172）。此外，BOB 组患者术前疼痛水平明显更高（p=0.014）。术后，BOB 组与 No BOB 组之间 CS 无显著差异（p=0.6738）。CS 的平均改善无统计学意义（p=0.2218）。
与髋关节和膝关节置换手术不同，TSA 后，骨关节炎的轻度程度不会对功能结果或主观满意度产生不利影响。常规 X 线片上的骨关节炎程度与术后临床结果无关。因此，进行解剖型全肩关节置换术的决策应取决于患者的疼痛程度和生活质量的丧失。
