Rauck Ryan C, Eck Eric P, Chang Brenda, Craig Edward V, Dines Joshua S, Dines David M, Warren Russell F, Gulotta Lawrence V
Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA.
Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN USA.
HSS J. 2020 Dec;16(Suppl 2):293-299. doi: 10.1007/s11420-019-09721-y. Epub 2019 Dec 9.
Reverse shoulder arthroplasty (RSA) is a common treatment of a variety of disabling shoulder conditions. The purpose of this study was to determine revision-free survivorship after RSA using a medialized glenoid and lateralized onlay-type humerus implant and to identify etiologies of revision.
All RSAs performed using the Comprehensive Reverse Shoulder System (Zimmer Biomet, Inc.; Warsaw, IN, USA) at one institution from 2008 to 2014 were identified through a retrospective review. Charts were reviewed to determine whether the RSA was a primary or revision surgery. Patients were contacted by telephone, and survivorship was defined as no subsequent surgery after RSA. Of the 526 RSAs performed, responses were obtained from 403 patients (77%). A Kaplan-Meier analysis was performed to determine survivorship over time. A test was used to determine differences between revision rates after RSA.
Minimum follow-up was 3 years, and average follow-up was 4.83 ± 1.60 years. Survivorship was 96% at 2 years and 93% at 5 years after RSA. Revisions were performed for instability ( = 8), humeral tray-taper junction failure ( = 5), acute fracture ( = 4), infection ( = 3), glenoid loosening ( = 3), osteolysis ( = 1), or notching ( = 1). Fourteen of the 151 patients (9.2%) who had surgery prior to RSA required revision after RSA. Having shoulder surgery prior to RSA was associated with higher rates of subsequent revision after RSA.
Overall, survivorship after RSA using a medialized glenoid and lateralized onlay-type humerus RSA is high, and prostheses implanted in native shoulders have lower rates of revision at midterm follow-up. Instability (1.9%) was the most common reason for revision.
反肩关节置换术（RSA）是治疗多种致残性肩部疾病的常用方法。本研究的目的是确定使用内移肩胛盂和外移嵌贴式肱骨假体的RSA术后无翻修的生存率，并确定翻修的病因。
通过回顾性研究确定了2008年至2014年在一家机构使用综合反肩关节系统（美国印第安纳州华沙市Zimmer Biomet公司）进行的所有RSA手术。查阅病历以确定RSA是初次手术还是翻修手术。通过电话联系患者，将生存率定义为RSA术后无后续手术。在进行的526例RSA手术中，403例患者（77%）获得了回复。采用Kaplan-Meier分析来确定随时间的生存率。使用检验来确定RSA术后翻修率之间的差异。
最短随访时间为3年，平均随访时间为4.83±1.60年。RSA术后2年生存率为96%，5年生存率为93%。翻修的原因包括不稳定（n = 8）、肱骨干假体柄-锥形连接失败（n = 5）、急性骨折（n = 4）、感染（n = 3）、肩胛盂松动（n = 3）、骨溶解（n = 1）或切口（n = 1）。在RSA术前接受手术的151例患者中有14例（9.2%）在RSA术后需要翻修。RSA术前进行肩部手术与RSA术后较高的后续翻修率相关。
总体而言，使用内移肩胛盂和外移嵌贴式肱骨RSA术后生存率较高，在中期随访中，植入初次肩关节的假体翻修率较低。不稳定（1.9%）是最常见的翻修原因。
