Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
J Shoulder Elbow Surg. 2021 Nov;30(11):e689-e701. doi: 10.1016/j.jse.2021.04.029. Epub 2021 May 5.
Complications and revisions following anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty have deleterious effects on patient function and satisfaction. The purpose of this study is to evaluate patient-specific, implant-specific and technique-specific risk factors for intraoperative complications, postoperative complications, and the occurrence of revisions after aTSA and rTSA.
A total of 2964 aTSA and 5616 rTSA patients were enrolled in an international database of primary shoulder arthroplasty. Intra- and postoperative complications, as well as revisions, were reported and evaluated. Multivariate analyses were performed to quantify the risk factors associated with complications and revisions.
aTSA patients had a significantly higher complication rate (P = .0026) and a significantly higher revision rate (P < .0001) than rTSA patients, but aTSA patients also had a significantly longer average follow-up (P < .0001) than rTSA patients. No difference (P = .2712) in the intraoperative complication rate was observed between aTSA and rTSA patients. Regarding intraoperative complications, female sex (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.17-3.68) and previous shoulder surgery (OR 2.9, 95% CI 1.73-4.90) were identified as significant risk factors. In regard to postoperative complications, younger age (OR 0.987, 95% CI 0.977-0.996), diagnosis of rheumatoid arthritis (OR 1.76, 95% 1.12-2.65), and previous shoulder surgery (OR 1.42, 95% CI 1.16-1.72) were noted to be risks factors. Finally, in regard to revision surgery, younger age (OR 0.964, 95% CI 0.933-0.998), more glenoid retroversion (OR 1.03, 95% CI 1.001-1.058), larger humeral stem size (OR 1.09, 95% CI 1.01-1.19), larger humeral liner thickness or offset (OR 1.50, 95% CI 1.18-1.96), larger glenosphere diameter (OR 1.16, 95% CI 1.07-1.26), and more intraoperative blood loss (OR 1.002, 95% CI 1.001-1.004) were noted to be risk factors.
Studying the impact of numerous patient- and implant-specific risk factors and determining their impact on complications and revision shoulder arthroplasty can assist surgeons in counseling patients and guide patient expectations following aTSA or rTSA. Care should be taken in patients with a history of previous shoulder surgery, who are at increased risk of both intra- and postoperative complications.
解剖型全肩关节置换术（aTSA）和反式全肩关节置换术（rTSA）后的并发症和翻修对患者的功能和满意度有不良影响。本研究旨在评估与 aTSA 和 rTSA 相关的患者特异性、假体特异性和技术特异性的术中并发症、术后并发症和翻修的风险因素。
共有 2964 例 aTSA 和 5616 例 rTSA 患者纳入了一项原发性肩关节置换术的国际数据库。报告和评估了术中及术后并发症和翻修。进行了多变量分析以量化与并发症和翻修相关的风险因素。
与 rTSA 患者相比，aTSA 患者的并发症发生率（P =.0026）和翻修率（P <.0001）均显著更高，但 aTSA 患者的平均随访时间也显著更长（P <.0001）。未观察到 aTSA 和 rTSA 患者之间的术中并发症发生率存在差异（P =.2712）。关于术中并发症，女性（比值比 [OR] 2.0，95%置信区间 [CI] 1.17-3.68）和既往肩部手术（OR 2.9，95% CI 1.73-4.90）被确定为显著风险因素。关于术后并发症，年龄较小（OR 0.987，95% CI 0.977-0.996）、类风湿性关节炎诊断（OR 1.76，95% 1.12-2.65）和既往肩部手术（OR 1.42，95% CI 1.16-1.72）被认为是风险因素。最后，在翻修手术方面，年龄较小（OR 0.964，95% CI 0.933-0.998）、肩盂后倾较大（OR 1.03，95% CI 1.001-1.058）、肱骨柄尺寸较大（OR 1.09，95% CI 1.01-1.19）、肱骨衬垫厚度或偏心距较大（OR 1.50，95% CI 1.18-1.96）、肱骨头直径较大（OR 1.16，95% CI 1.07-1.26）和术中出血量较大（OR 1.002，95% CI 1.001-1.004）被认为是风险因素。
研究众多患者和假体特异性风险因素的影响，并确定其对 aTSA 或 rTSA 后并发症和翻修肩关节置换术的影响，可以帮助外科医生为患者提供咨询并指导患者对 aTSA 或 rTSA 的期望。对于有既往肩部手术史的患者应谨慎，他们存在术中及术后并发症的风险增加。
