University of Illinois College of Medicine, Rockford, Illinois, U.S.A.
Orthopedic Sports Medicine Surgery Service, OrthoIllinois, Rockford, Illinois, U.S.A.
Arthroscopy. 2020 Jun;36(6):1508-1514. doi: 10.1016/j.arthro.2020.01.045. Epub 2020 Feb 10.
To determine whether arthroscopy is an effective means to diagnose and treat postoperative pain in anatomic total shoulder arthroplasty (TSA) and reverse TSA patients.
A 2-year retrospective chart review of patients with a painful shoulder arthroplasty was performed. Patients included in the study had a painful shoulder after previous shoulder arthroplasty without gross signs of infection, severely elevated laboratory markers, implant loosening, or glenoid arthrosis after hemiarthroplasty. Visual analog scale scores, physical examination findings, laboratory studies, culture results, pathology reports, operative records, and postoperative treatment data were collected.
The study cohort included 6 male and 7 female patients. Between 2016 and 2018, 7 TSA and 6 reverse TSA patients underwent arthroscopic debridement of adhesions and synovitis with tissue biopsy for cultures and fresh-frozen sections. We arthroscopically treated adhesive capsulitis, subacromial impingement, and acromioclavicular joint arthritis in 3 patients. Three patients required extensive debridement for profound synovitis. All 6 patients had negative findings of cultures and frozen sections, and none required revision arthroplasty. Their average follow-up period was 18.6 months (range, 9-32 months), with improvement in the mean visual analog scale score from 8.2 of 10 (range, 6-10) to 2.5 of 10 (range, 2-8). Two patients had arthroscopic cultures showing Cutibacterium acnes infection. Both required revision with an antibiotic spacer. Findings of cultures and fresh-frozen sections at revision were consistent with arthroscopic findings. Arthroscopic evaluation in 5 additional patients identified mechanical implant failure or a rotator cuff tear.
Arthroscopy is a viable option to evaluate and treat painful shoulder arthroplasty. We were able to successfully treat 46% of patients (6 of 13) with arthroscopic procedures, preventing the need for revision arthroplasty. Arthroscopic frozen section and culture results had a 100% correlation with open frozen section and culture results in patients who had cultures obtained.
Level IV, case series.
确定关节镜检查是否是诊断和治疗解剖型全肩关节置换术（TSA）和反式 TSA 患者术后疼痛的有效方法。
对先前有肩部置换术后疼痛的患者进行了为期 2 年的回顾性图表审查。研究纳入的患者在接受肩部置换术后肩部疼痛，且无明显感染迹象、实验室标志物显著升高、植入物松动或半肩置换术后肩盂关节炎。收集了视觉模拟评分、体格检查结果、实验室研究、培养结果、病理报告、手术记录和术后治疗数据。
研究队列包括 6 名男性和 7 名女性患者。2016 年至 2018 年，7 例 TSA 和 6 例反式 TSA 患者接受了关节镜下粘连松解和滑膜切除术，并进行组织活检以进行培养和新鲜冷冻切片。我们对 3 例患者进行了粘连性关节囊炎、肩峰下撞击和肩锁关节关节炎的关节镜治疗。3 例患者需要广泛清创以治疗严重的滑膜炎。所有 6 例患者的培养和冷冻切片均未见异常，均无需翻修关节置换术。他们的平均随访时间为 18.6 个月（范围，9-32 个月），平均视觉模拟评分从 10 分的 8.2 分（范围，6-10 分）改善至 10 分的 2.5 分（范围，2-8 分）。2 例患者的关节镜培养显示痤疮丙酸杆菌感染。两者均需要使用抗生素间隔器进行翻修。翻修时的培养和新鲜冷冻切片结果与关节镜结果一致。对另外 5 例患者进行的关节镜评估发现机械性植入物失败或肩袖撕裂。
关节镜检查是评估和治疗肩部置换术后疼痛的可行选择。我们能够通过关节镜手术成功治疗 46%（13 例中的 6 例）的患者，避免了翻修关节置换术的需要。在进行关节镜检查时获得培养物的患者中，关节镜冷冻切片和培养结果与开放冷冻切片和培养结果具有 100%的相关性。
IV 级，病例系列。
