Department of Orthopaedics, The Permanente Medical Group, Sacramento, CA, USA.
Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA.
J Shoulder Elbow Surg. 2020 Oct;29(10):2089-2096. doi: 10.1016/j.jse.2020.02.024. Epub 2020 Jun 5.
Anatomic total shoulder arthroplasty (TSA) is a proven treatment for glenohumeral joint osteoarthritis, with superior results compared with hemiarthroplasty. However, glenoid component loosening remains a problem and is one of the most common causes of failure in TSA. Multiple component designs have been developed in an attempt to reduce loosening rates. The purpose of this study was to evaluate risk of revision after anatomic TSA according to the glenoid component design.
We conducted a cohort study including patients aged ≥18 years who underwent primary elective TSA for the diagnosis of osteoarthritis between 2010 and 2017. Patients with missing implant information, who received stemless humeral implants, or who received augmented glenoid implants, were excluded. Glenoid component designs used were categorized into 4 mutually exclusive treatment groups: polyethylene central-pegged ingrowth, polyethylene-metal hybrid, polyethylene all-cemented pegged, and polyethylene cemented keeled. Multivariable competing risk regression was used to evaluate the risk of glenoid loosening as a cause-specific revision by the glenoid component design.
Of the 5566 TSA included in the final cohort, 39.2% of glenoid implants were polyethylene central-pegged ingrowth, 31.1% were polyethylene-metal hybrid, 26.0% were polyethylene all-cemented pegged, and 3.6% were polyethylene cemented keeled. At 6-year final follow-up, 4.1% of TSA were revised for any cause, and 1.4% for glenoid loosening. Compared with the polyethylene central-pegged ingrowth design, no difference in glenoid loosening revision risk was observed for the polyethylene-metal hybrid design (hazard ratio [HR] = 1.15, 95% confidence interval [CI] = 0.42-3.20). However, both the polyethylene all-cemented pegged (HR = 2.48, 95% CI = 1.08-5.66) and polyethylene cemented keeled (HR = 3.84, 95% CI = 1.13-13.00) designs had higher risks for revision due to glenoid loosening.
We observed glenoid component designs to be associated with differential risks in revision due to glenoid loosening with polyethylene all-cemented pegged glenoids and polyethylene cemented keeled glenoids having higher risks when compared with polyethylene central-pegged ingrowth glenoids. Surgeons may want to consider the glenoid component design when performing anatomic TSA.
解剖全肩关节置换术（TSA）是治疗肩盂肱关节骨关节炎的一种成熟方法，其疗效优于半肩关节置换术。然而，肩胛盂假体松动仍然是一个问题，也是 TSA 失败的最常见原因之一。为了降低松动率，已经开发出多种假体设计。本研究的目的是根据肩胛盂假体设计评估解剖型 TSA 后的翻修风险。
我们进行了一项队列研究，纳入了 2010 年至 2017 年期间因骨关节炎接受初次择期 TSA 的年龄≥18 岁的患者。排除了植入物信息缺失、使用无柄肱骨假体或接受增强型肩胛盂假体的患者。根据使用的肩胛盂假体设计将患者分为 4 个相互排斥的治疗组：聚乙烯中央栓钉型植入物、聚乙烯-金属混合植入物、聚乙烯全骨水泥固定栓钉型植入物和聚乙烯骨水泥固定龙骨型植入物。采用多变量竞争风险回归分析评估不同肩胛盂假体设计导致的肩胛盂松动翻修的风险。
在最终队列中，5566 例 TSA 中，39.2%的肩胛盂假体为聚乙烯中央栓钉型植入物，31.1%为聚乙烯-金属混合植入物，26.0%为聚乙烯全骨水泥固定栓钉型植入物，3.6%为聚乙烯骨水泥固定龙骨型植入物。在 6 年最终随访时，4.1%的 TSA 因任何原因翻修，1.4%因肩胛盂松动翻修。与聚乙烯中央栓钉型植入物设计相比，聚乙烯-金属混合植入物设计的肩胛盂松动翻修风险无显著差异（风险比[HR] = 1.15，95%置信区间[CI] = 0.42-3.20）。然而，聚乙烯全骨水泥固定栓钉型植入物（HR = 2.48，95%CI = 1.08-5.66）和聚乙烯骨水泥固定龙骨型植入物（HR = 3.84，95%CI = 1.13-13.00）的设计与因肩胛盂松动而翻修的风险显著相关。
我们发现肩胛盂假体设计与因肩胛盂松动而翻修的风险相关，与聚乙烯中央栓钉型植入物相比，聚乙烯全骨水泥固定栓钉型植入物和聚乙烯骨水泥固定龙骨型植入物的翻修风险更高。外科医生在进行解剖型 TSA 时可能需要考虑肩胛盂假体设计。
