Holy Cross Orthopedic Institute, Fort Lauderdale, Florida.
J Bone Joint Surg Am. 2021 May 19;103(10):913-920. doi: 10.2106/JBJS.19.01398.
While anatomic total shoulder arthroplasty (TSA) has historically been considered the ideal treatment for end-stage glenohumeral osteoarthritis, reverse shoulder arthroplasty (RSA) has recently gained popularity. With substantial differences in implant design and cost between TSA and RSA, further investigation of outcomes and value is needed to support recent trends. The purpose of this study was to use the average and incremental cost-effectiveness ratio (ACER and ICER) and the procedure value index (PVI) to examine differences in outcomes and value between TSA and RSA for treatment of glenohumeral osteoarthritis with an intact rotator cuff.
We performed a retrospective matched-cohort study of patients treated with primary shoulder arthroplasty for osteoarthritis with an intact rotator cuff who had a minimum 2-year follow-up. Outcome measures analyzed included the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) questionnaire, visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE), and overall satisfaction. Patients treated with TSA were matched 4:1 to those treated with RSA based on sex, age, and preoperative SST score. Value differences between TSA and RSA were calculated. Radiographs were analyzed for preoperative glenoid classification and postoperative radiolucent lines and gross loosening.
Two hundred and fifty-two TSA-treated patients were matched to 63 RSA-treated patients with no significant differences in sex, age, or preoperative SST score. Total hospitalization costs, charges, and reimbursements along with outcome improvements in units of minimal clinically important differences (MCIDs) and patient satisfaction did not differ between the groups. For RSA, the implant cost was significantly higher than that for TSA, but the operating room, anesthesia, and cement costs were lower. The TSA group had a 3.2% rate of gross glenoid loosening and a 2.4% revision rate. There was no loosening or revision in the RSA group. None of the value analytics differed between groups even after inclusion of the outcomes and costs of early TSA revisions.
TSA and RSA demonstrated similar outcomes and value when used to manage glenohumeral osteoarthritis with an intact rotator cuff.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
尽管解剖型全肩关节置换术（TSA）一直被认为是治疗终末期肩关节炎的理想方法，但反向肩关节置换术（RSA）最近越来越受欢迎。由于 TSA 和 RSA 在植入物设计和成本方面存在很大差异，因此需要进一步研究结果和价值，以支持最近的趋势。本研究的目的是使用平均和增量成本效益比（ACER 和 ICER）和程序价值指数（PVI）来检查 TSA 和 RSA 治疗肩袖完整的肩关节炎的结果和价值差异。
我们对接受肩袖完整的原发性肩关节置换术治疗的肩关节炎患者进行了回顾性匹配队列研究，这些患者至少有 2 年的随访。分析的结果测量包括简单肩部测试（SST）、美国肩肘外科医师协会（ASES）问卷、疼痛视觉模拟量表（VAS）、单一评估数字评估（SANE）和总体满意度。根据性别、年龄和术前 SST 评分，将 TSA 治疗的患者与 RSA 治疗的患者以 4:1 的比例进行匹配。计算 TSA 和 RSA 之间的价值差异。分析术前关节盂分类和术后透光线和大体松动的 X 线片。
252 例 TSA 治疗的患者与 63 例 RSA 治疗的患者匹配，性别、年龄和术前 SST 评分无显著差异。两组总住院费用、费用和报销以及以最小临床重要差异（MCID）为单位的结果改善和患者满意度无差异。对于 RSA，植入物成本明显高于 TSA，但手术室、麻醉和水泥成本较低。TSA 组有 3.2%的大体关节盂松动率和 2.4%的翻修率。RSA 组无松动或翻修。即使包括早期 TSA 翻修的结果和成本，两组的价值分析也没有差异。
当用于治疗肩袖完整的肩关节炎时，TSA 和 RSA 显示出相似的结果和价值。
治疗水平 III。请参阅作者说明以获取完整的证据水平描述。
