Medical College of Georgia, Augusta, GA, USA.
Bordeaux Merignac Sports Clinic, Bordeaux, France.
J Shoulder Elbow Surg. 2021 Apr;30(4):811-818. doi: 10.1016/j.jse.2020.07.028. Epub 2020 Aug 4.
Complications after anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty can be devastating to a patient's quality of life and require revisions that are costly to both the patient and the health care system. The purpose of this study is to determine the types, incidence, and timing of complications following aTSA and rTSA using an international database of patients who received a single-platform total shoulder arthroplasty system, in order to quantify the types of failure modes and the differences that occur between aTSA and rTSA.
A total of 2224 aTSA (male-female, 1090:1134) and 4158 rTSA (male-female, 1478:2680) patients were enrolled in an international database of primary shoulder arthroplasty performed by 40 different surgeons in the United States and Europe. Adverse events and revisions reported for these 6382 patients were analyzed to identify the most common failure modes associated for both aTSA and rTSA.
For the 2224 aTSA patients, 239 adverse events were reported for a complication rate of 10.7% and 124 revisions for a revision rate of 5.6%. The top 3 complications for aTSA were rotator cuff tear/subscapularis failure (n = 69; complication rate = 3.1%, revision rate = 1.9%), aseptic glenoid loosening (n = 55; complication rate = 2.5%, revision rate = 1.9%), and infection (n = 28; complication rate = 1.3%, revision rate = 0.8%). For the 4158 rTSA patients, 372 adverse events were reported for a complication rate of 8.9% and 104 revisions for a revision rate of 2.5%. The top 3 complications for rTSA were acromial/scapular fracture/pain (n = 102; complication rate = 2.5%, revision rate = 0.0%), instability (n = 60; complication rate = 1.4%, revision rate = 1.0%), and pain (n = 49; complication rate = 1.2%, revision rate = 0.2%).
This large database analysis quantified complication and revision rates for aTSA and rTSA. We found aTSA and rTSA complication rates of 10.7% and 8.9%, respectively; with revision surgery rates of 5.6% and 2.5%, respectively. The 2 most common complications for each prosthesis type (aTSA: subscapularis/rotator cuff tears, aseptic glenoid loosening; rTSA: acromial/scapular fractures, instability) were unique to each device. The rate of infection was similar for both. Future prosthesis and technique development should work to mitigate these common complication types in order to reduce their rate of occurrence.
解剖型全肩关节置换术（aTSA）和反式全肩关节置换术（rTSA）后的并发症可能对患者的生活质量造成严重影响，需要进行翻修，这对患者和医疗保健系统来说都是昂贵的。本研究的目的是使用接受单平台全肩关节置换系统的患者国际数据库，确定 aTSA 和 rTSA 后的并发症类型、发生率和发生时间，以便量化失效模式的类型以及 aTSA 和 rTSA 之间发生的差异。
共纳入 2224 例 aTSA（男女比例为 1090:1134）和 4158 例 rTSA（男女比例为 1478:2680）患者，这些患者均由美国和欧洲的 40 位不同外科医生在国际数据库中进行了初次肩关节置换。对这些 6382 例患者报告的不良事件和翻修情况进行分析，以确定与 aTSA 和 rTSA 相关的最常见失效模式。
对于 2224 例 aTSA 患者，报告了 239 例不良事件，并发症发生率为 10.7%，翻修率为 5.6%。aTSA 的前 3 种并发症为肩袖撕裂/肩胛下肌失败（n = 69；并发症发生率 = 3.1%，翻修率 = 1.9%）、无菌性肩胛盂松动（n = 55；并发症发生率 = 2.5%，翻修率 = 1.9%）和感染（n = 28；并发症发生率 = 1.3%，翻修率 = 0.8%）。对于 4158 例 rTSA 患者，报告了 372 例不良事件，并发症发生率为 8.9%，翻修率为 2.5%。rTSA 的前 3 种并发症为肩峰/肩胛骨折/疼痛（n = 102；并发症发生率 = 2.5%，翻修率 = 0.0%）、不稳定（n = 60；并发症发生率 = 1.4%，翻修率 = 1.0%）和疼痛（n = 49；并发症发生率 = 1.2%，翻修率 = 0.2%）。
这项大型数据库分析量化了 aTSA 和 rTSA 的并发症和翻修率。我们发现 aTSA 和 rTSA 的并发症发生率分别为 10.7%和 8.9%，翻修手术率分别为 5.6%和 2.5%。每种假体类型（aTSA：肩胛下肌/肩袖撕裂、无菌性肩胛盂松动；rTSA：肩峰/肩胛骨折、不稳定）的 2 种最常见并发症是各自器械特有的。两种假体的感染率相似。未来的假体和技术发展应努力减轻这些常见并发症类型，以降低其发生率。
