NYU Langone Orthopedic Hospital, New York, NY.
Orthopaedic Center of the Rockies, Ft. Collins, Colorado.
J Bone Joint Surg Am. 2020 Nov 4;102(21):1865-1873. doi: 10.2106/JBJS.19.00946.
Uncorrected superior glenoid wear in patients managed with reverse total shoulder arthroplasty (rTSA) can result in increased complications, including baseplate failure. The present study quantifies the clinical and radiographic outcomes of patients with Favard type-E1, E2, and E3 glenoid deformity who were managed with rTSA with use of a superior or superior/posterior augmented glenoid baseplate.
We retrospectively reviewed the records for 68 patients with shoulder arthritis and Favard type-E1, E2, or E3 glenoid deformity who were managed with primary rTSA and a 10° superior augmented or 10° superior/8° posterior augmented baseplate. The mean duration of follow-up was 40 months (range, 24 to 85 months). Outcomes were assessed preoperatively and at the latest follow-up with shoulder range of motion and use of outcome scores including the Simple Shoulder Test (SST), University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Shoulder Pain and Disability Index (SPADI) score. Radiographs were evaluated preoperatively and at the time of the latest follow-up. Differences in preoperative and postoperative range of motion and outcome metrics were assessed with use of a 2-tailed Student t test.
The majority of patients experienced clinically meaningful improvements in terms of pain and function following rTSA with a superior or superior/posterior augment, with 94% of patients rating themselves as "much better" (73.5%) or "better" (20.5%) at the time of the latest follow-up. At least 88% of the patients exceeded the minimum clinically important difference (MCID) threshold, and 75% of patients exceeded the substantial clinical benefit (SCB) threshold, for each of the clinical outcome metrics and range of motion. Five complications were reported (prevalence, 7.4%), including acromial stress fracture (2 patients), posttraumatic scapular neck fracture (1 patient), chronic shoulder pain (1 patient), and aseptic glenoid loosening (1 patient).
The present short-term clinical and radiographic study demonstrated that shoulder arthropathy with superior glenoid wear patterns (Favard types E1, E2, and E3) can be successfully treated with rTSA with a superior or superior/posterior augmented baseplate. Longer-term clinical and radiographic follow-up is necessary to confirm that these promising short-term results are durable.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
在接受反向全肩关节置换术（rTSA）治疗的患者中，未矫正的上肩胛盂磨损可导致并发症增加，包括基板失效。本研究定量评估了接受 rTSA 治疗的 Favard 型 E1、E2 和 E3 肩胛盂畸形患者的临床和影像学结果，这些患者使用了上或上/后增强肩胛盂基板。
我们回顾性分析了 68 例患有肩关节炎和 Favard 型 E1、E2 或 E3 肩胛盂畸形的患者的记录，这些患者接受了初次 rTSA 治疗，并使用了 10°上增强或 10°上/8°后增强基板。平均随访时间为 40 个月（范围 24 至 85 个月）。使用肩关节活动范围和包括简易肩部测试（SST）、加利福尼亚大学洛杉矶分校（UCLA）评分、美国肩肘外科医生（ASES）评分、Constant 评分和肩部疼痛和残疾指数（SPADI）评分在内的结果评分对术前和末次随访时的结果进行评估。术前和末次随访时拍摄 X 线片。使用双尾学生 t 检验评估术前和术后关节活动范围和结果指标的差异。
接受上或上/后增强基板的 rTSA 治疗后，大多数患者在疼痛和功能方面均有明显改善，94%的患者在末次随访时自我评估为“好得多”（73.5%）或“更好”（20.5%）。对于每个临床结果指标和关节活动范围，至少 88%的患者超过了最小临床重要差异（MCID）阈值，75%的患者超过了实质性临床获益（SCB）阈值。报告了 5 例并发症（发生率为 7.4%），包括肩峰应力性骨折（2 例）、创伤后肩胛颈骨折（1 例）、慢性肩部疼痛（1 例）和无菌性肩胛盂松动（1 例）。
本短期临床和影像学研究表明，对于上肩胛盂磨损模式（Favard 型 E1、E2 和 E3）的肩关节关节炎，rTSA 联合上或上/后增强基板可成功治疗。需要进行更长期的临床和影像学随访，以确认这些有前途的短期结果具有持久性。
治疗性 IV 级。有关证据水平的完整描述，请参见作者说明。
