Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2020 Jun;29(6):1188-1196. doi: 10.1016/j.jse.2019.10.003. Epub 2019 Dec 31.
Biomechanical studies show that inlay glenoid components in total shoulder arthroplasty (TSA) can reduce edge loading and opposite-edge lift-off forces with humeral translation compared with onlay glenoids. However, clinical data for these implants are lacking. We report clinical outcomes and return to activities after anatomic TSA with an inlay glenoid component and a stemless ovoid humeral head in an active, young patient population.
A retrospective review of TSA with an inlay glenoid component and an ovoid humeral head component was performed for 27 shoulders. Patients were evaluated with patient-reported outcome measures, range of motion, and radiographs. Return to occupational and sporting activity, complications, and reoperations were analyzed.
A total of 27 shoulders were available for minimum 2-year follow-up. Age averaged 52.1 years, and 92.6% of shoulders were in male patients. The preoperative Walch grade was A1 or A2 in 15 shoulders (55%), B1 in 8 (30%), and B2 in 4 (15%). Patients showed significant improvements in patient-reported outcome measures, active forward flexion, and external rotation (P < .001) with no reoperations. At an average of 3.7 months, the rate of return to work was 92.6%, with 76.0% of those patients returning to their preoperative occupational demand level. At an average of 9.1 months, 75% of patients who responded to our custom survey returned to sport, with 50% achieving the same level or a higher level of sporting activity. Annual postoperative radiographs revealed no inlay component loosening.
Anatomic TSA with an inlay glenoid coupled with a stemless ovoid humeral head in an active population resulted in improved clinical outcomes, no reoperations or radiographic loosening, and a high rate of return to activity at shorter-term follow-up.
生物力学研究表明，与覆盖型肩胛盂相比，在全肩关节置换术（TSA）中使用嵌入式肩胛盂假体可减少肱骨平移时的边缘负荷和对侧边缘抬起力。然而，这些植入物的临床数据尚缺乏。我们报告了在活跃的年轻患者人群中，使用嵌入式肩胛盂假体和无柄卵形肱骨头进行解剖型 TSA 的临床结果和活动恢复情况。
对 27 例接受嵌入式肩胛盂假体和卵形肱骨头假体的 TSA 患者进行回顾性研究。通过患者报告的结果测量、活动范围和 X 线片评估患者。分析了活动恢复情况、并发症和再手术。
共有 27 例肩接受了至少 2 年的随访。患者平均年龄为 52.1 岁，92.6%的肩为男性。术前 Walch 分级 A1 或 A2 者 15 例（55%），B1 者 8 例（30%），B2 者 4 例（15%）。患者在患者报告的结果测量、主动前屈和外展方面均有显著改善（P <.001），且无再手术。平均 3.7 个月时，患者的工作恢复率为 92.6%，其中 76.0%的患者恢复到术前的职业需求水平。平均 9.1 个月时，75%的回复调查的患者恢复运动，其中 50%的患者达到或高于术前的运动水平。术后每年的 X 线片均未显示嵌入式假体松动。
在活跃人群中，采用解剖型 TSA 联合嵌入式肩胛盂假体和无柄卵形肱骨头假体可改善临床结果，无再手术或影像学松动，且在短期随访时活动恢复率较高。
