Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
Exactech Inc., Gainesville, FL, USA.
Eur J Orthop Surg Traumatol. 2023 May;33(4):961-969. doi: 10.1007/s00590-022-03233-y. Epub 2022 Mar 1.
To evaluate the effect of prior anterior shoulder instability surgery (SIS) on the outcomes and complications of primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA).
Between 2007 and 2018, 38 primary total shoulder arthroplasties (TSA) (22 aTSA and 16 rTSA) with a prior SIS and a minimum of 2 years of follow-up were identified. This cohort was matched 1:3 based on age, sex, body mass index, year of surgery, and dominant shoulder. aTSA and rTSA were matched to patients with primary osteoarthritis (OA) and rotator cuff tear arthropathy (CTA), respectively.
TSA produced similar postoperative pain, ROM, patient-reported outcome measures, complications, and revisions in those with prior SIS vs. controls. aTSA with prior SIS demonstrated worse final postoperative abduction (116° vs. 133°; P = 0.046) and abduction improvement (24° vs. 47°; P = 0.034) compared to OA controls. Both aTSA and rTSA with prior SIS demonstrated significant improvements from baseline across all metrics, with no significant differences between the groups. aTSA and rTSA with prior SIS demonstrated no differences to controls in complications (4.6% vs. 6.1%; P = .786 and 0% vs. 6.3%. P = .183) or revisions (4.6% vs. 4.6%; P = .999 and 0% vs. 4.2%; P = .279).
TSA after prior SIS surgery can improve both pain and function without adversely increasing the rates of complications or revision surgery. When compared to patients without prior SIS, aTSA demonstrated worse abduction; however, all other functional differences remained statistically similar.
III; Retrospective Cohort Comparison; Treatment Study.
评估先前的肩关节不稳定手术（SIS）对初次解剖全肩关节置换术（aTSA）和反向全肩关节置换术（rTSA）的结果和并发症的影响。
在 2007 年至 2018 年期间，确定了 38 例初次全肩关节置换术（TSA）（22 例 aTSA 和 16 例 rTSA），这些患者均有先前的 SIS 病史，并至少随访 2 年。该队列根据年龄、性别、体重指数、手术年份和优势肩进行 1:3 匹配。aTSA 和 rTSA 分别与原发性骨关节炎（OA）和肩袖撕裂性关节炎（CTA）患者相匹配。
在有先前 SIS 病史的患者与对照组之间，TSA 术后疼痛、ROM、患者报告的结果测量、并发症和翻修情况相似。与 OA 对照组相比，有先前 SIS 病史的 aTSA 术后最终外展角度（116° vs. 133°；P = 0.046）和外展改善角度（24° vs. 47°；P = 0.034）较差。与对照组相比，aTSA 和 rTSA 术前均有明显改善，两组之间无显著差异。有先前 SIS 病史的 aTSA 和 rTSA 在并发症（4.6% vs. 6.1%；P = .786 和 0% vs. 6.3%；P = .183）或翻修（4.6% vs. 4.6%；P = .999 和 0% vs. 4.2%；P = .279）方面无差异。
在先前的 SIS 手术后进行 TSA 可以改善疼痛和功能，而不会增加并发症或翻修手术的发生率。与无先前 SIS 病史的患者相比，aTSA 的外展角度较差；然而，所有其他功能差异仍具有统计学意义。
III；回顾性队列比较；治疗研究。
