Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
J Shoulder Elbow Surg. 2022 Apr;31(4):747-754. doi: 10.1016/j.jse.2021.08.016. Epub 2021 Sep 17.
Whether or how the position of the humeral tray (inlay or onlay) in reverse shoulder arthroplasty (RSA) affects outcomes is unclear. Our goal was to compare the clinical and radiographic results of RSA systems with inlay vs. onlay designs but with similar neck shaft angles (NSAs) and lateralized glenospheres.
We screened the institutional database at our tertiary academic center for patients who underwent primary RSA (with a lateralized glenosphere and a 135° NSA) from 2009 through 2017. The indication for surgery was glenohumeral osteoarthritis with glenoid bone loss (Walch classification A2, B2, B3, or C) and an intact rotator cuff. All patients were followed for a minimum of 2 years (mean, 47 months; range, 24-123 months). The humeral tray design was inlay for 79 patients and onlay for 71. All patients underwent preoperative and postoperative evaluations, including physical examination, radiography, and patient-reported outcome measures (visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and Western Ontario Osteoarthritis of the Shoulder index).
Compared with preoperative values, both groups achieved minimal clinically important differences in range of motion and patient-reported outcomes at the final follow-up. We found no significant differences between groups in any of these measures at the final follow-up. Rates of revision (inlay, 3.8% vs. onlay, 1.4%), scapular notching (inlay, 5.1% vs. onlay, 7.0%), acromial stress fracture (inlay, 0% vs. onlay, 2.8%), and tuberosity resorption (inlay, 25% vs. onlay, 27%) were not significantly different between groups (all, P > .05).
For patients with glenohumeral osteoarthritis with glenoid bone loss and an intact rotator cuff who underwent RSA using a lateralized glenosphere prosthesis with a 135° NSA, there were no significant differences between the inlay and onlay groups for range of motion, patient-reported outcomes, or complication rates. These findings are limited to this off-label indication for RSA.
在反式肩关节置换术（RSA）中，肱骨托的位置（嵌入式或覆盖式）是否以及如何影响结果尚不清楚。我们的目标是比较 RSA 系统中嵌入式与覆盖式设计的临床和影像学结果，但要具有相似的颈干角（NSA）和侧向化肱骨头。
我们在我们的三级学术中心的机构数据库中筛选了 2009 年至 2017 年期间接受原发性 RSA（带有侧向化肱骨头和 135° NSA）的患者。手术指征为肩肱关节炎合并肩胛盂骨丢失（Walch 分类 A2、B2、B3 或 C）和完整的肩袖。所有患者的随访时间均至少为 2 年（平均 47 个月；范围 24-123 个月）。肱骨托设计为嵌入式 79 例，覆盖式 71 例。所有患者均接受术前和术后评估，包括体格检查、影像学检查和患者报告的结果测量（疼痛视觉模拟评分、美国肩肘外科医生评分、简单肩部测试和安大略西部肩关节炎指数）。
与术前相比，两组在最终随访时的运动范围和患者报告的结果均达到了最小临床重要差异。在最终随访时，我们发现两组在这些指标中均无显著差异。翻修率（嵌入式，3.8%比覆盖式，1.4%）、肩胛盂切迹（嵌入式，5.1%比覆盖式，7.0%）、肩峰应力性骨折（嵌入式，0%比覆盖式，2.8%）和小结节吸收（嵌入式，25%比覆盖式，27%）在两组之间无显著差异（均 P >.05）。
对于肩肱关节炎合并肩胛盂骨丢失和完整肩袖的患者，在使用侧向化肱骨头假体和 135° NSA 进行 RSA 时，嵌入式和覆盖式组在运动范围、患者报告的结果或并发症发生率方面没有显著差异。这些发现仅限于 RSA 的这种非适应证。
