Wakefield Orthopaedic Clinic, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia.
Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia.
J Shoulder Elbow Surg. 2020 Sep;29(9):1821-1830. doi: 10.1016/j.jse.2020.01.101. Epub 2020 Apr 15.
Wedge-shaped porous metal augments were used to address bone deficiency in shoulder arthroplasty as part of a hybrid combination of high-density polyethylene, polymethyl methacrylate bone cement, and porous metal implant. This article presents an ongoing review of the use of the generically designed augments in the shoulder to address glenoid retroversion as part of anatomic total shoulder arthroplasty (aTSA).
Seventy-five shoulders in 66 patients (23 women and 43 men, aged 42-85 years) with Walch grade B2 or C glenoids underwent porous metal glenoid augment (PMGA) insertion as part of aTSA. Patients underwent preoperative 3-dimensional (3D) templating; based on that planning, patients received either a 15° or 30° PMGA wedge (secured by screws to the native glenoid) to correct excessive glenoid retroversion before a standard glenoid component was implanted using bone cement. Neither patient-specific guides nor navigation were used. Intraoperative glenoid alignment was assessed using a reusable guide that referenced the anterior scapular neck. Patients were prospectively assessed using shoulder functional assessments (Oxford Shoulder Score [OSS], American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], visual analog scale [VAS] pain scores, and forward elevation [FE]) preoperatively; at 3, 6, and 12 months postoperation; and yearly thereafter, with similar radiologic surveillance.
Of the total consecutive series, 49 shoulders had a follow-up of greater than 24 months, with a median follow-up of 48 months (range: 24-87 months). For this cohort, median outcome scores improved for OSS (21 to 44), ASES (24 to 92), VAS (7 to 0), and FE (90° to 140°) from preoperative outcomes to the most recent review, respectively. Four patients died, but no others were lost to follow-up. Apart from 1 infection at 18 months postoperatively and 1 minor peg perforation, there were no complications, hardware failures, implant displacements, significant lucency, or posterior resubluxations. Radiographs showed good incorporation of the wedge augment, with correction of glenoid retroversion from median 22° (13° to 46°) to 4° (17° to anteversion 16°). All but 4 glenoids were corrected to within the target range (less than 10° retroversion), and only 2 glenoid components were implanted outside 15° of neutral glenoid version.
The porous metal wedge-shaped augments effectively addressed posterior glenoid deficiency as part of aTSA for rotator cuff intact osteoarthritis, producing satisfactory clinical outcomes with no signs of impending future failure.
楔形多孔金属增强物被用于解决肩关节置换术中的骨缺损问题，作为高密度聚乙烯、聚甲基丙烯酸甲酯骨水泥和多孔金属植入物的混合组合的一部分。本文介绍了通用设计的增强物在肩关节中的应用，以解决作为解剖全肩关节置换术（aTSA）一部分的关节盂后倾问题。
75 个肩（66 例患者，23 名女性和 43 名男性，年龄 42-85 岁）接受了多孔金属关节盂增强物（PMGA）植入，以解决 Walch 分级 B2 或 C 型关节盂的问题。患者接受术前三维（3D）模板设计；根据该计划，患者接受 15°或 30°PMGA 楔形物（通过螺钉固定在原生关节盂上），以在使用骨水泥植入标准关节盂组件之前纠正过度的关节盂后倾。均未使用患者特异性导向器或导航。术中使用可重复使用的导向器评估关节盂的位置，该导向器参考肩胛颈前侧。前瞻性评估患者的肩部功能（牛津肩评分[OSS]、美国肩肘外科医生标准化肩部评估表[ASES]、视觉模拟评分[VAS]疼痛评分和前屈[FE]），包括术前；术后 3、6 和 12 个月；此后每年一次，同时进行类似的放射学监测。
在总连续系列中，49 个肩的随访时间超过 24 个月，中位随访时间为 48 个月（范围：24-87 个月）。对于该队列，OSS（21 到 44）、ASES（24 到 92）、VAS（7 到 0）和 FE（90°到 140°）的中位术后评分分别从术前到最近一次评估都有所改善。4 名患者死亡，但无其他患者失访。除了 1 例术后 18 个月感染和 1 例小钉穿孔外，无并发症、硬件失败、植入物移位、明显透亮线或后脱位。影像学显示楔形增强物良好的融合，关节盂后倾从中位 22°（13°至 46°）矫正至 4°（17°至前倾 16°）。除 4 个关节盂外，所有关节盂均矫正至目标范围内（小于 10°后倾），只有 2 个关节盂组件植入的位置不在中立关节盂版本 15°以外。
多孔金属楔形增物作为肩袖完整骨关节炎的 aTSA 的一部分，有效地解决了后部关节盂缺损问题，产生了令人满意的临床结果，没有未来失败的迹象。
