Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA.
Exactech Inc., Gainesville, FL, USA.
J Shoulder Elbow Surg. 2021 Oct;30(10):e621-e628. doi: 10.1016/j.jse.2021.02.010. Epub 2021 Mar 4.
Reverse total shoulder arthroplasty (RTSA) is a successful procedure, often allowing patients to achieve better range of motion (ROM) compared with their preoperative baseline. However, there is a subset of patients who either fail to improve or lose ROM postoperatively. These patients are at increased risk of poor satisfaction and patient-reported outcomes. To date, characteristics of this subset of patients have not been well described. The purpose of this study is to determine risk factors associated with loss of ROM after primary RTSA.
A retrospective review using a commercial international RTSA database (Exactech Inc., Gainesville, FL, USA) of patients who underwent primary RTSA between 2007 and 2017 was performed. A total of 123 (7.7%) shoulders lost ≥10° of forward elevation (FE) (group 1, P) and 183 (11.4%) lost ≥10° of external rotation (ER) (group 2, P). Univariate and multivariate analyses were performed comparing these patients with control cohorts to evaluate risk factors for loss of motion.
Better preoperative abduction, FE, ER, and internal rotation were each associated with greater loss of FE (P < .001) and ER (P < .001) postoperatively. Higher preoperative Simple Shoulder Test (P < .001, P < .001), Constant (P < .001, P < .001), Shoulder Pain and Disability Index (P < .001, P < .001), American Shoulder Elbow Surgeons (P < .001), and University of California at Los Angeles (P < .001) scores were also strongly associated with loss of ROM postoperatively. Other factors associated with a higher risk of losing ROM included a diagnosis of irreparable rotator cuff tear (P = .038), rotator cuff arthropathy (P = .017, P ≤ .001), and inflammatory arthropathy (P = .021). After multivariate analysis, higher preoperative FE (P < .001), internal rotation (P = -.018), and weight (P = .008) remained significant predictors of loss of FE. Better preoperative FE (P = .003), ER (P < .001), and University of California at Los Angeles score (P < .001) remained significant predictors of loss of ER. Patients who lost FE or ER were more likely to report lower satisfaction scores than their counterparts who did not lose ROM (P < .001, P < .001).
Patients with greater preoperative shoulder ROM or higher patient-reported outcomes are at higher risk of losing ROM after primary RTSA. They are also at higher risk of reporting lower postoperative satisfaction, though the majority were still satisfied. Surgeons should strongly counsel patients with well-preserved preoperative function on the risk of loss of ROM.
反向全肩关节置换术（RTSA）是一种成功的手术，通常能使患者术后的活动范围（ROM）较术前基线水平得到改善。然而，有一部分患者术后的 ROM 要么没有改善，要么出现了丢失。这些患者的满意度和患者报告的结局较差的风险增加。迄今为止，尚未很好地描述这部分患者的特征。本研究的目的是确定与原发性 RTSA 后 ROM 丢失相关的危险因素。
使用商业性国际 RTSA 数据库（美国佛罗里达州盖恩斯维尔的 Exactech Inc.）对 2007 年至 2017 年间接受原发性 RTSA 的患者进行回顾性分析。共有 123 个（7.7%）肩部在前向抬高（FE）方面丢失≥10°（组 1，P），183 个（11.4%）在外部旋转（ER）方面丢失≥10°（组 2，P）。通过比较这些患者与对照组的单变量和多变量分析，评估与运动丢失相关的危险因素。
术前更好的外展、FE、ER 和内旋与术后 FE（P <.001）和 ER（P <.001）丢失增加相关。术前 Simple Shoulder Test（P <.001，P <.001）、Constant（P <.001，P <.001）、肩痛和残疾指数（P <.001，P <.001）、美国肩肘外科医生（P <.001）和加州大学洛杉矶分校（P <.001）评分较高也与术后 ROM 丢失强烈相关。与更高的 ROM 丢失风险相关的其他因素包括无法修复的肩袖撕裂（P =.038）、肩袖关节炎（P =.017，P ≤.001）和炎症性关节炎（P =.021）。多变量分析后，术前更高的 FE（P <.001）、内旋（P = -.018）和体重（P =.008）仍然是 FE 丢失的显著预测因素。术前更好的 FE（P =.003）、ER（P <.001）和加州大学洛杉矶分校评分（P <.001）仍然是 ER 丢失的显著预测因素。FE 或 ER 丢失的患者比未丢失 ROM 的患者更有可能报告较低的满意度评分（P <.001，P <.001）。
术前肩部 ROM 较好或患者报告结局较高的患者，在接受原发性 RTSA 后更有可能出现 ROM 丢失。尽管大多数患者仍满意，但他们也更有可能报告术后满意度较低。外科医生应强烈告知术前功能保存良好的患者 ROM 丢失的风险。
