Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Bone Joint Surg Am. 2021 May 19;103(10):879-886. doi: 10.2106/JBJS.20.00555.
Glenoid component loosening is a primary cause of failure of anatomical total shoulder arthroplasty (TSA) and is commonly associated with glenoid bone loss. The purpose of the present study was to evaluate the outcome and survival following revision to a reverse total shoulder arthroplasty (RSA) for the treatment of loosening of a polyethylene cemented glenoid component in the setting of failed TSA.
Between 2010 and 2017, 151 shoulders underwent revision to RSA for the treatment of loosening of an anatomical polyethylene glenoid component. Shoulders with staged reconstruction for the treatment of infection were excluded. One hundred and twenty-seven patients (67 women and 60 men) had a single-stage reconstruction and were available for follow-up. The mean age at the time of surgery was 70 years (range, 41 to 93 years). In all cases, the humeral component was revised and a standard glenoid baseplate was utilized. Bone graft was used at the discretion of the treating surgeon. Medical records and radiographs were reviewed to collect demographic, intraoperative, and postoperative data; to quantify glenoid bone loss; and to determine the radiographic outcome. The mean duration of follow-up was 35 months (range, 24 to 84 months).
Revision to RSA resulted in significant improvements in terms of pain and motion. Sixteen shoulders (13%) underwent revision surgery for the treatment of baseplate loosening. Radiographic baseplate loosening was present in 6 additional shoulders (overall rate of baseplate loosening, 17%). Intraoperative fracture or fragmentation of the greater tuberosity occurred in 30 shoulders (24%). Other reoperations included resection for deep infection (3 shoulders), arthroscopic biopsies for unexplained persistent pain (2 shoulders), humeral tray exchange for dislocation (2 shoulders), revision for humeral loosening (1 shoulder), irrigation and debridement for hematoma (1 shoulder), and internal fixation of periprosthetic fracture (1 shoulder) (overall reoperation rate, 20%). Among shoulders with surviving implants at the time of the most recent follow-up, pain was rated as none or mild in 83 shoulders (65.4%) and the average active elevation and external rotation were 132° and 38°, respectively. With the numbers available, no risk factors for failure could be identified.
Revision RSA for the treatment of loosening of an anatomical polyethylene component was associated with a 17% glenoid mechanical failure rate. Although this procedure resulted in improvements in terms of pain and function, it was not universally successful and thus needs further refinement in order to improve outcomes.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
肩盂组件松动是解剖型全肩关节置换术（TSA）失败的主要原因，通常与肩盂骨丢失有关。本研究的目的是评估在 TSA 失败后，采用反向全肩关节置换术（RSA）治疗聚乙烯骨水泥固定的肩盂组件松动的治疗效果和生存率。
2010 年至 2017 年，151 例肩采用 RSA 翻修术治疗解剖型聚乙烯肩盂组件松动。排除因感染分期重建的病例。127 例患者（67 例女性和 60 例男性）行单阶段重建并获得随访。手术时的平均年龄为 70 岁（41 岁至 93 岁）。所有病例均更换肱骨头组件，并使用标准的肩盂基板。植骨由治疗医生决定。回顾病历和 X 线片以收集人口统计学、术中及术后数据；定量评估肩盂骨丢失；并确定影像学结果。平均随访时间为 35 个月（24 个月至 84 个月）。
RSA 翻修可显著改善疼痛和运动功能。16 例（13%）因基板松动而行翻修手术。另外 6 例（总体基板松动率为 17%）出现放射学基板松动。30 例（24%）术中出现大结节骨折或碎裂。其他再次手术包括深部感染切除（3 例）、不明原因持续性疼痛行关节镜活检（2 例）、脱位行肱骨托置换（2 例）、肱骨头松动行翻修（1 例）、血肿冲洗引流（1 例）和假体周围骨折内固定（1 例）（再次手术率为 20%）。末次随访时，植入物存活的肩中，83 例（65.4%）疼痛评为无或轻度，平均主动抬高和外展分别为 132°和 38°。根据现有的数字，无法确定失败的危险因素。
采用 RSA 翻修治疗解剖型聚乙烯组件松动的肩盂机械失败率为 17%。虽然该手术可改善疼痛和功能，但并非普遍成功，因此需要进一步改进以提高疗效。
治疗性 IV 级。请参阅作者说明，以获取完整的证据水平描述。
