Atlantic Orthopaedic Specialists, Virginia Beach, VA, USA.
Exactech, Inc., Gainesville, FL, USA.
J Shoulder Elbow Surg. 2022 Sep;31(9):1789-1795. doi: 10.1016/j.jse.2022.02.014. Epub 2022 Mar 22.
As the number of anatomic and reverse total shoulder arthroplasty (TSA) procedures increase, there will be a natural increase in patients who undergo staged bilateral TSA procedures. Bilateral TSAs have been shown to improve patient outcomes; however, it is unknown whether these patients experience side-to-side differences in clinical outcomes and satisfaction between shoulders. Understanding these differences is imperative for accurate patient and provider expectations.
An international multicenter registry was used to identify patients who underwent staged bilateral TSAs from April 2007 to October 2019 with a minimum of 2-year follow-up. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) outcomes and satisfaction ratings were compared between dominant and nondominant shoulders, and first and second arthroplasties. Side-to-side differences in postoperative ASES and unequal satisfaction ratings were also explored by using regression analyses to identify potential factors influencing these differences.
A total of 60 patients (22 bilateral anatomic TSAs, 38 bilateral reverse TSAs) were identified for inclusion. Group analyses revealed that bilateral TSA patients demonstrated similar functional outcomes and satisfaction regardless of dominance and surgery sequence. Type of TSA, specifically bilateral reverse TSAs, significantly predicted greater side-to-side differences in postoperative ASES scores (P = .025), indicating reverse TSA patients demonstrated greater between-sides differences in postoperative functional outcomes compared with those undergoing anatomic TSAs. Additionally, a larger proportion of bilateral reverse TSA patients reported unequal satisfaction between shoulders (31.6%) compared with anatomic TSA patients (9.1%). Logistic regression analysis revealed that greater side-to-side differences in postoperative ASES scores were found to increase the likelihood of reporting unequal satisfaction between shoulders (odds ratio 1.11, P < .001), which may explain this outcome.
Most patients who undergo bilateral TSAs can expect similar outcomes on both shoulders regardless of dominance and surgery sequence. However, we did find patients who had discordant results between shoulders. Those who underwent reverse TSAs more frequently reported unequal satisfaction with their TSA procedures, which is likely due to larger side-to-side differences in postoperative function. It is unclear why these differences occurred, but this information may be important for providers to remember when counseling these patients for accurate postoperative expectations.
随着解剖型和反式全肩关节置换术（TSA）数量的增加，接受分期双侧 TSA 手术的患者自然会增加。双侧 TSA 已被证明可改善患者的预后；然而，尚不清楚这些患者在双肩的临床结果和满意度方面是否存在双侧差异。了解这些差异对于准确的患者和提供者期望至关重要。
使用国际多中心登记处，从 2007 年 4 月至 2019 年 10 月，确定了至少有 2 年随访的分期双侧 TSA 患者。比较了优势肩和非优势肩、初次和第二次关节置换术的美国肩肘外科医生协会（ASES）标准肩部评估表（ASES）结果和满意度评分。还通过回归分析探索了术后 ASES 侧间差异和不等的满意度评分，以确定影响这些差异的潜在因素。
共纳入 60 例患者（22 例双侧解剖型 TSA，38 例双侧反式 TSA）。组间分析表明，双侧 TSA 患者无论优势和手术顺序如何，其功能结果和满意度均相似。TSA 类型，特别是双侧反式 TSA，显著预测术后 ASES 评分的侧间差异更大（P=0.025），表明与接受解剖型 TSA 的患者相比，反式 TSA 患者术后功能结果的双侧差异更大。此外，更多的双侧反式 TSA 患者报告双肩之间的满意度不等（31.6%），而解剖型 TSA 患者（9.1%）则较少。逻辑回归分析表明，术后 ASES 评分的侧间差异越大，报告双肩之间满意度不等的可能性越大（优势比 1.11，P<0.001），这可能解释了这一结果。
大多数接受双侧 TSA 的患者无论优势和手术顺序如何，都可以预期双肩的结果相似。但是，我们确实发现了一些患者的双肩结果不一致。那些接受反式 TSA 的患者更频繁地报告 TSA 手术的满意度不等，这可能是由于术后功能的双侧差异较大。尚不清楚为什么会出现这些差异，但这些信息对于提供者在为这些患者提供准确的术后预期时可能很重要。
