Tashjian Robert Z, Granger Erin, Broschinsky Kortnie, Kawakami Jun, Chalmers Peter N
Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
JSES Int. 2020 Jun 10;4(3):662-668. doi: 10.1016/j.jseint.2020.03.016. eCollection 2020 Sep.
Revision reverse total shoulder arthroplasty (RTSA) reliably improves shoulder pain and function in patients with failed shoulder arthroplasty, although it can lead to significant postoperative complications. The purpose of this study was to determine the effect of postoperative complications on shoulder pain and function after revision RTSA.
We evaluated 36 patients at an average of 4.3 years (range, 2-8.6 years) after revision of a shoulder arthroplasty to RTSA. Of these patients, 9 had a failed anatomic total shoulder arthroplasty, 23 had a failed hemiarthroplasty, and 4 had a failed RTSA. The American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) pain score were evaluated postoperatively, and patients with and without postoperative complications were compared.
The final ASES score and VAS pain score were 61 ± 23 and 2.4 ± 2.3, respectively. A major postoperative complication occurred in 7 patients (19%) (infection in 3, hematoma in 1, instability in 1, and acromial and/or scapular spine fracture in 2). Further surgical treatment was required in 5 patients (14%) (irrigation and débridement and component exchange for infection in 3, irrigation and débridement for hematoma in 1, and open reduction-internal fixation of scapular spine fracture in 1). On comparison of clinical outcomes between patients with and patients without complications, the ASES score and VAS pain score were significantly worse in patients with complications vs. those without them (ASES score, 43 ± 24 vs. 66 ± 21 [ = .04]; VAS pain score, 4.3 ± 2 vs. 2 ± 2.2 [ = .03]).
Revision RTSA resulted in postoperative pain and shoulder function comparable to primary RTSA reported in the literature, although postoperative complications led to clinically significant declines in function and increases in pain.
翻修性反式全肩关节置换术（RTSA）能可靠地改善肩关节置换失败患者的肩部疼痛和功能，尽管它可能导致显著的术后并发症。本研究的目的是确定术后并发症对翻修性RTSA术后肩部疼痛和功能的影响。
我们评估了36例接受肩关节置换翻修为RTSA术后平均4.3年（范围2 - 8.6年）的患者。其中，9例解剖型全肩关节置换失败，23例半肩关节置换失败，4例RTSA失败。术后评估美国肩肘外科医师（ASES）评分和视觉模拟量表（VAS）疼痛评分，并比较有无术后并发症的患者。
最终ASES评分为61±23，VAS疼痛评分为2.4±2.3。7例患者（19%）发生了严重术后并发症（3例感染，1例血肿，1例不稳定，2例肩峰和/或肩胛冈骨折）。5例患者（14%）需要进一步手术治疗（3例因感染行冲洗清创和假体置换，1例因血肿行冲洗清创，1例因肩胛冈骨折行切开复位内固定）。比较有并发症和无并发症患者的临床结果，有并发症患者的ASES评分和VAS疼痛评分显著低于无并发症患者（ASES评分，43±24 vs. 66±21 [P = .04]；VAS疼痛评分，4.3±2 vs. 2±2.2 [P = .03]）。
翻修性RTSA术后疼痛和肩部功能与文献报道的初次RTSA相当，尽管术后并发症导致功能显著下降和疼痛增加。
