Szolomayer Lauren K, Kuether Justin, Kassam Hafiz F, Mata Fink Ana, Regnell Elsa, Kovacevic David, Blaine Theodore A
Department of Orthopedics and Rehabilitation, Yale Medical School, New Haven, Connecticut.
J Shoulder Elb Arthroplast. 2019 Jan 9;3:2471549218822389. doi: 10.1177/2471549218822389. eCollection 2019.
Glenoid loosening and instability are among the most common complications after anatomic total shoulder arthroplasty (TSA), resulting in poor function. Posterior instability is one contributing factor. The purpose of this study is to report the clinical and radiographic outcomes of a series of patients treated with posterior capsule plication for intraoperative posterior instability during TSA. It is hypothesized that patients undergoing this procedure will have improvement in posterior stability intraoperatively while not limiting their ROM postoperatively.
Patients of the senior author were identified who had undergone TSA with posterior capsule plication from 2014 to 2015 based on Current Procedural Terminology (CPT) codes. Their records and preoperative radiographs were retrospectively reviewed for demographic data and preoperative range of motion (ROM) which was documented in the clinic notes. Patients were then evaluated postoperatively to determine the outcomes after TSA with posterior capsule plication. Final follow-up was conducted via telephone survey.
Nineteen patients were identified for review; however, only 14 had all imaging available. The mean age at the time of surgery was 63 years. There were 2 A1, 6 B1, and 6 B2 Walch-type glenoids based on preoperative imaging. All but one had equivalent or better ROM for active forward elevation and external rotation postoperatively. One patient required return to operating room at 5 months after developing adhesive capsulitis.
This study indicates that the use of posterior capsule plication during TSA is a safe method to address posterior subluxation, while still allowing for improved ROM postoperatively.
盂肱关节松动和不稳定是解剖型全肩关节置换术（TSA）后最常见的并发症，会导致功能不佳。后方不稳定是其中一个促成因素。本研究的目的是报告一系列在TSA手术中因术中后方不稳定而接受后方关节囊折叠术治疗的患者的临床和影像学结果。假设接受该手术的患者术中后方稳定性会得到改善，同时术后不会限制其活动范围（ROM）。
根据现行手术操作术语（CPT）编码，确定了2014年至2015年期间接受TSA并进行后方关节囊折叠术的资深作者的患者。回顾他们的病历和术前X线片，以获取人口统计学数据和术前活动范围（ROM），这些数据记录在临床笔记中。然后对患者进行术后评估，以确定TSA联合后方关节囊折叠术后的结果。通过电话调查进行最终随访。
确定了19例患者进行回顾；然而，只有14例有完整的影像学资料。手术时的平均年龄为63岁。根据术前影像学检查，有2个A1型、6个B1型和6个B2型Walch型盂肱关节。除1例患者外，所有患者术后主动前屈和外旋的ROM均相等或更好。1例患者在发生粘连性关节囊炎5个月后需要返回手术室。
本研究表明，在TSA手术中使用后方关节囊折叠术是解决后方半脱位的一种安全方法，同时仍能使术后ROM得到改善。
