Department of Physical and Occupational Therapy, Duke University Health Systems, Durham, NC, USA.
North Carolina Orthopedic Clinic, Durham, NC, USA.
J Shoulder Elbow Surg. 2021 Apr;30(4):929-941. doi: 10.1016/j.jse.2020.09.028. Epub 2020 Oct 22.
This systematic review aimed to investigate differences in clinical outcomes, patient-reported outcomes (PROs), and complication types and rates among preoperative diagnoses following reverse total shoulder arthroplasty (RTSA): rotator cuff tear arthropathy, primary osteoarthritis, massive irreparable rotator cuff tear, proximal humeral fracture, rheumatoid arthritis (RA), and revision of anatomic arthroplasty (Rev).
Three electronic databases were searched from inception to January 2020.
The inclusion criteria were (1) patients with a minimum age of 60 years who underwent RTSA for the stated preoperative diagnoses, (2) a minimum of 2 years' follow-up, and (3) preoperative and postoperative values for clinical outcomes and PROs.
Risk of bias was determined by the Methodological Index for Non-randomized Studies tool and the modified Downs and Black tool. Weighted means for clinical outcomes and PROs were calculated for each preoperative diagnosis.
A total of 53 studies were included, of which 36 (68%) were level IV retrospective case series. According to the Methodological Index for Non-randomized Studies tool, 33 studies (62%) showed a high risk of bias; the 3 randomized controlled trials showed a low risk of bias on the modified Downs and Black tool. RTSA improved clinical outcomes and PROs for all preoperative diagnoses. The Rev group had poorer final outcomes as noted by a lower American Shoulder and Elbow Surgeons score (69) and lower pain score (1.8) compared with the other preoperative diagnoses (78-82 and 0.4-1.4, respectively). The RA group showed the highest complication rate (28%), whereas the osteoarthritis group showed the lowest rate (1.4%).
Studies in the RTSA literature predominantly showed a high risk of bias. All preoperative diagnoses showed improvements; Rev patients showed the worse clinical outcomes and PROs, and RA patients showed higher complication rates. The preoperative diagnosis in RTSA patients can impact outcomes and complications.
本系统评价旨在研究反式全肩关节置换术（RTSA）后术前诊断的临床结果、患者报告的结局（PROs）以及并发症类型和发生率的差异：肩袖撕裂性关节炎、原发性骨关节炎、巨大不可修复肩袖撕裂、肱骨近端骨折、类风湿关节炎（RA）和解剖型关节置换术的翻修（Rev）。
从建库到 2020 年 1 月，共检索了 3 个电子数据库。
纳入标准为（1）患有所述术前诊断并接受 RTSA 的至少 60 岁患者，（2）至少 2 年随访，以及（3）临床结果和 PROs 的术前和术后值。
采用非随机研究方法指标和改良的 Downs 和 Black 工具确定偏倚风险。为每个术前诊断计算临床结果和 PROs 的加权平均值。
共纳入 53 项研究，其中 36 项（68%）为 IV 级回顾性病例系列研究。根据非随机研究方法指标，33 项研究（62%）显示出高偏倚风险；3 项随机对照试验在改良的 Downs 和 Black 工具上显示出低偏倚风险。对于所有术前诊断，RTSA 改善了临床结果和 PROs。Rev 组的最终结局较差，美国肩肘外科医生评分（69）和疼痛评分（1.8）较低，与其他术前诊断（分别为 78-82 和 0.4-1.4）相比。RA 组的并发症发生率最高（28%），而骨关节炎组的发生率最低（1.4%）。
RTSA 文献中的研究主要显示出高偏倚风险。所有术前诊断均显示出改善；Rev 患者的临床结果和 PROs 较差，RA 患者的并发症发生率较高。RTSA 患者的术前诊断会影响结果和并发症。
