Shah Sarav S, Gaal Benjamin T, Roche Alexander M, Namdari Surena, Grawe Brian M, Lawler Macy, Dalton Stewart, King Joseph J, Helmkamp Joshua, Garrigues Grant E, Wright Thomas W, Schoch Bradley S, Flik Kyle, Otto Randall J, Jones Richard, Jawa Andrew, McCann Peter, Abboud Joseph, Horneff Gabe, Ross Glen, Friedman Richard, Ricchetti Eric T, Boardman Douglas, Tashjian Robert Z, Gulotta Lawrence V
American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA.
JSES Int. 2020 Sep 7;4(4):929-943. doi: 10.1016/j.jseint.2020.07.017. eCollection 2020 Dec.
Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this 2-part study was to systematically review each of the most common complications of RSA, limiting each search to publications in 2010 or later. In this part (part I), we examined (1) scapular notching (SN), (2) periprosthetic infection (PJI), (3) mechanical failure (glenoid or humeral component), and (4) neurologic injury (NI).
Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Overall, 113 studies on SN, 62 on PJI, 34 on mechanical failure, and 48 on NI were included in our reviews. Univariate analysis was performed with the χ or Fisher exact test.
The Grammont design had a higher SN rate vs. all other designs combined (42.5% vs. 12.3%, < .001). The onlay humeral design had a lower rate than the lateralized glenoid design (10.5% vs. 14.8%, < .001). The PJI rate was 2.4% for primary RSA and 2.6% for revision RSA. The incidence of glenoid and humeral component loosening was 2.3% and 1.4%, respectively. The Grammont design had an increased NI rate vs. all other designs combined (0.9% vs. 0.1%, = .04).
Focused systematic reviews of the recent literature with a large volume of RSAs demonstrate that with the use of non-Grammont modern prosthesis designs, complications including SN, PJI, glenoid component loosening, and NI are significantly reduced compared with previous studies. As the indications for RSA continue to expand, it is imperative to accurately track the rates and types of complications to justify its cost and increased indications.
在全球范围内，反肩关节置换术（RSA）已从Grammont设计转向现代假体设计。这项分为两部分的研究旨在系统回顾RSA最常见的每种并发症，每次检索仅限于2010年或之后发表的文献。在这一部分（第一部分），我们研究了：（1）肩胛切迹（SN）；（2）假体周围感染（PJI）；（3）机械故障（关节盂或肱骨头部件）；（4）神经损伤（NI）。
按照系统评价和Meta分析的首选报告项目指南，在PubMed数据库进行了四项独立检索。我们的综述共纳入了113项关于SN的研究、62项关于PJI的研究、34项关于机械故障的研究以及48项关于NI的研究。采用χ²检验或Fisher精确检验进行单因素分析。
Grammont设计的SN发生率高于所有其他设计的总和（42.5%对12.3%，P <.001）。肱骨覆盖设计的发生率低于关节盂侧方化设计（10.5%对14.8%，P <.001）。初次RSA的PJI发生率为2.4%，翻修RSA的发生率为2.6%。关节盂和肱骨头部件松动的发生率分别为2.3%和1.4%。Grammont设计的NI发生率高于所有其他设计的总和（0.9%对0.1%，P = 0.04）。
对大量RSA近期文献进行的针对性系统评价表明，与先前研究相比，使用非Grammont现代假体设计可显著降低包括SN、PJI、关节盂部件松动和NI在内的并发症。随着RSA的适应证不断扩大，准确跟踪并发症的发生率和类型对于证明其成本和适应证增加的合理性至关重要。
