Zhang Baoliang, Chen Guanghui, Fan Tianqi, Chen Zhongqiang
Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden, Road, Haidian District, Beijing, 100191, China.
Arthroplasty. 2020 Sep 1;2(1):25. doi: 10.1186/s42836-020-00045-5.
Though total shoulder arthroplasty (TSA) has been an acknowledged treatment option for glenohumeral osteoarthritis, resurfacing hemiarthroplasty (RHA) and stemmed hemiarthroplasty (SHA) may be preferred in some circumstances by surgeons, especially for treating young or active patients. However, decision-making between the RHA and SHA is controversial. Therefore, we conducted a meta-analysis to systematically compare two surgical procedures in terms of postoperative functional outcomes, range of motion (ROM), pain relief, complication rates, risk of revision.
The PubMed, Embase, Web of Science and Cochrane Library were searched from inception to January 1, 2020, for all articles that compared the clinical effectiveness and safety of RHA with SHA. All eligible studies were selected based on certain screening criteria. Two investigators independently conducted the quality assessment and extracted the data. Fixed-effect and random-effect models were used for pooled results according to the degree of heterogeneity. All statistical analyses were performed by employing Stata software 14.0.
A total of six comparative studies involving 2568 shoulders (1356 RHA and 1212 SHA) were included in the final analysis. Patients were followed up for at least 1 year in each study. Pooled results showed that RHA was associated with a better visual analog scale (SMD 0.61, p = 0.001) but higher revision rates (OR 1.50, p = 0.016) when compared to SHA. There were no significant differences in functional outcomes, such as Constant-Murley score (SMD 0.06, P = 0.878), American Shoulder and Elbow Surgeons score (SMD 0.05, P = 0.880), Western Ontario Osteoarthritis of the Shoulder index (SMD 0.43, p = 0.258) and quick-Disabilities of the Arm, Shoulder and Hand score (SMD 0.06, p = 0.669). In addition, no differences were observed in forward flexion (SMD 0.16, p = 0.622), external rotation (SMD -0.17, P = 0.741) and overall complication rates (OR 1.42, p = 0.198).
This is the first meta-analysis to investigate the clinical efficacy and safety of RHA in comparison with SHA for the treatment of glenohumeral osteoarthritis. The results demonstrated that the two surgical techniques were equivalent in terms of postoperative functional outcomes and complication rate. However, RHA provided greater pain relief but posed a higher risk for revision than SHA. More high-quality studies with long-term follow up are warranted to give more convincing evidence.
尽管全肩关节置换术（TSA）已被公认为是治疗盂肱关节骨关节炎的一种治疗选择，但在某些情况下，外科医生可能更倾向于采用表面置换半关节成形术（RHA）和带柄半关节成形术（SHA），尤其是在治疗年轻或活跃的患者时。然而，RHA和SHA之间的决策存在争议。因此，我们进行了一项荟萃分析，以系统地比较这两种手术方法在术后功能结果、活动范围（ROM）、疼痛缓解、并发症发生率和翻修风险方面的差异。
检索了PubMed、Embase、Web of Science和Cochrane图书馆从创刊至2020年1月1日的所有比较RHA与SHA临床有效性和安全性的文章。所有符合条件的研究均根据特定的筛选标准进行选择。两名研究人员独立进行质量评估并提取数据。根据异质性程度，采用固定效应和随机效应模型进行汇总结果分析。所有统计分析均使用Stata软件14.0进行。
最终分析共纳入6项比较研究，涉及2568个肩关节（1356个RHA和1212个SHA）。每项研究中患者的随访时间至少为1年。汇总结果显示，与SHA相比，RHA的视觉模拟评分更好（标准化均数差[SMD]为0.61，p = 0.001），但翻修率更高（比值比[OR]为1.50，p = 0.016）。在功能结果方面，如Constant-Murley评分（SMD为0.06，P = 0.878）、美国肩肘外科医生评分（SMD为0.05，P = 0.880）、西安大略肩关节炎指数（SMD为0.43，p = 0.258）和手臂、肩部和手部快速残疾评分（SMD为0.06，p = 0.669），两者无显著差异。此外，在前屈（SMD为0.16，p = 0.622）、外旋（SMD为 -0.17，P = 0.741）和总体并发症发生率（OR为1.42，p = 0.198）方面也未观察到差异。
这是第一项比较RHA与SHA治疗盂肱关节骨关节炎临床疗效和安全性的荟萃分析。结果表明，这两种手术技术在术后功能结果和并发症发生率方面相当。然而，RHA在缓解疼痛方面效果更佳，但与SHA相比，其翻修风险更高。需要更多高质量的长期随访研究来提供更有说服力的证据。
