Shoulder and Elbow Surgery, Schulthess Clinic, Zürich, Switzerland.
Shoulder and Elbow Surgery, Schulthess Clinic, Zürich, Switzerland; Research, Teaching and Development, Schulthess Clinic, Zürich, Switzerland.
J Shoulder Elbow Surg. 2020 Nov;29(11):2282-2291. doi: 10.1016/j.jse.2020.01.090. Epub 2020 May 20.
The use of reverse total shoulder arthroplasty (RTSA) has dramatically increased in recent years with the advent of new prosthesis designs regularly entering the market. We define the rate of local complications during the first 2 years after RTSA with the Univers Revers prosthesis and describe the changes in radiologic outcomes, as well as function, pain, satisfaction, and quality of life.
This multicenter, prospective case series included rotator cuff tear arthropathy patients who underwent RTSA with the Univers Revers. Incidence percentages of complications and pathologic radiographic changes were documented. Mixed-model linear regression was used to examine changes in range of motion, shoulder function (Constant score, Shoulder Pain and Disability Index, Subjective Shoulder Value), and quality of life (EQ-5D-5L [European Quality of Life 5 Dimensions 5 Level] and EQ-VAS [EuroQol Visual Analog Scale]).
Of 187 patients, 59.4% were women, and the mean age was 75.3 years (range, 56-91 years). Twenty-five percent of patients had a postoperative complication; 5 complications were severe (2.7%, 5 of 187), whereby 2 were implant related (1.1%; 95% confidence interval [CI], 0.1%-3.8%). The incidence of scapular notching was 10.6% (95% CI, 6.5%-16%). After 2 years, abduction, flexion, and abduction strength improved by 54° (95% CI, 50°-58°), 57° (95% CI, 53°-60°), and 5 kg (95% CI, 4-5 kg), respectively (P < .001), whereas external rotation at 0° (1°; 95% CI, -1° to 3°) did not improve (P = .4). The Constant score improved by 39 (95% CI, 38-41); Shoulder Pain and Disability Index, by 50 (95% CI, 47-52); and Subjective Shoulder Value, by 43 (95% CI, 41-45) (P < .001). Furthermore, the EQ-5D-5L index value improved by 0.31 (95% CI, 0.30-0.33), and the EQ-VAS score improved by 16 (95% CI, 14-18) (P < .001).
Our case series showed a low complication rate with a consistent clinically relevant and statistically significant improvement across most clinical and patient-reported outcomes for the Univers Revers. Long-term safety requires further investigation.
随着新型假体设计不断进入市场,近年来反向全肩关节置换术(RTSA)的应用显著增加。我们用 Univers 反式假体定义 RTSA 后 2 年内的局部并发症发生率,并描述放射学结果以及功能、疼痛、满意度和生活质量的变化。
这是一项多中心前瞻性病例系列研究,纳入了接受 Univers 反式假体行 RTSA 的肩袖撕裂性关节炎患者。记录并发症和病理放射变化的发生率百分比。采用混合模型线性回归分析来检查活动范围、肩部功能(Constant 评分、肩痛和残疾指数、主观肩部值)和生活质量(EQ-5D-5L [欧洲五维健康量表 5 维度 5 水平] 和 EQ-VAS [欧洲质量五维量表视觉模拟评分])的变化。
在 187 名患者中,59.4%为女性,平均年龄为 75.3 岁(56-91 岁)。25%的患者发生术后并发症;5 例并发症严重(2.7%,187 例中的 5 例),其中 2 例与植入物有关(1.1%;95%置信区间[CI],0.1%-3.8%)。肩胛切迹发生率为 10.6%(95%CI,6.5%-16%)。术后 2 年,外展、前屈和外展力量分别提高了 54°(95%CI,50°-58°)、57°(95%CI,53°-60°)和 5kg(95%CI,4-5kg)(P<0.001),而外旋 0°(1°;95%CI,-1°至 3°)无改善(P=0.4)。Constant 评分提高了 39(95%CI,38-41);肩痛和残疾指数提高了 50(95%CI,47-52);主观肩部值提高了 43(95%CI,41-45)(P<0.001)。此外,EQ-5D-5L 指数值提高了 0.31(95%CI,0.30-0.33),EQ-VAS 评分提高了 16(95%CI,14-18)(P<0.001)。
我们的病例系列研究显示,Univers 反式假体的并发症发生率较低,大多数临床和患者报告的结果均有一致的临床相关和统计学显著改善。长期安全性需要进一步研究。