Matsui Yuki, Momma Daisuke, Suenaga Naoki, Urita Atsushi, Yoshioka Chika, Oizumi Naomi, Iwasaki Norimasa
Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan.
Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan.
J Orthop Sci. 2023 Jan;28(1):131-137. doi: 10.1016/j.jos.2021.10.012. Epub 2021 Nov 24.
Anatomical total shoulder arthroplasty (TSA) provides successful long-term outcomes but complications can occur after 10 years that require revision. Computed tomography (CT) is a useful tool for assessing radiolucent lines around the glenoid component of TSA; however, the merits of long-term post-TSA follow up with CT are unclear. The purpose of this study was to evaluate the long-term outcomes after TSA of Japanese population and to identify factors related to radiolucency around the glenoid component using CT.
A retrospective review was conducted of TSA patients who had completed at least 10 years of clinical follow up. Radiographs and CT images of the affected shoulder obtained at the last follow up were evaluated for radiolucent lines around the stem and each peg, superior inclination and retroversion of the glenoid component, subluxation index, and critical shoulder angle (CSA). Shoulder ROM, Constant-Murley score and UCLA score were compared between the preoperative and last follow up period.
Eighteen shoulders in 16 patients met the inclusion criteria. Mean patient age was 61 years, mean follow up period was 137 months, and mean Yian CT score was 19%. CT score was significantly highest in pegs located inferiorly (p < 0.05). Mean glenoid superior inclination was 12.6°, retroversion was -0.3°, subluxation index was 46%, and CSA was 33.7°. Glenoid superior inclination was significantly lower (p = 0.007) in shoulders with possible loosening than in cases with no loosening (5.0° vs 15.6°). Mean Constant score and UCLA score improved significantly after TSA, from 25.8 to 10.7 points preoperatively to 70.1 and 28.9 points postoperatively, respectively. Mean shoulder flexion, internal rotation, and external rotation also showed improvement postoperatively.
TSA provides good long-term outcomes. Radiolucency was present most frequently around the inferior pegs of the glenoid component. Glenoid superior inclination may affect the formation of radiolucent lines around glenoid pegs.
Level IV; Case Series; Treatment study.
解剖型全肩关节置换术（TSA）能带来成功的长期疗效，但10年后可能出现需要翻修的并发症。计算机断层扫描（CT）是评估TSA关节盂假体周围透亮线的有用工具；然而，TSA术后长期CT随访的价值尚不清楚。本研究的目的是评估日本人群TSA术后的长期疗效，并使用CT确定与关节盂假体周围透亮线相关的因素。
对至少完成10年临床随访的TSA患者进行回顾性研究。对最后一次随访时获得的患侧肩部X线片和CT图像进行评估，观察柄和每个固定钉周围的透亮线、关节盂假体的上倾角和后倾角、半脱位指数以及临界肩角（CSA）。比较术前和最后一次随访期间的肩关节活动度、Constant-Murley评分和UCLA评分。
16例患者的18个肩部符合纳入标准。患者平均年龄61岁，平均随访时间137个月，平均Yian CT评分为19%。位于下方的固定钉的CT评分显著最高（p < 0.05）。关节盂平均上倾角为12.6°，后倾角为-0.3°，半脱位指数为46%，CSA为33.7°。可能出现松动的肩部的关节盂上倾角显著低于无松动的病例（5.°对15.6°，p = 0.007）。TSA术后平均Constant评分和UCLA评分显著改善，术前分别为25.8分和10.7分，术后分别为70.1分和28.9分。术后平均肩关节前屈、内旋和外旋也有所改善。
TSA能带来良好的长期疗效。关节盂假体下方固定钉周围最常出现透亮线。关节盂上倾角可能影响关节盂固定钉周围透亮线的形成。
IV级；病例系列；治疗研究。
