Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Orthopedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA.
J Shoulder Elbow Surg. 2022 Jun;31(6S):S158-S165. doi: 10.1016/j.jse.2022.02.029. Epub 2022 Apr 1.
The Grammont-style reverse shoulder arthroplasty (RSA) relies on medialization and distalization of the shoulder center of rotation. Lateralized designs have recently gained popularity. The amount of lateralization, however, remains a controversial topic. The purpose of this study was to correlate the change in humeral offset (HO) with outcomes and complications following RSA. We hypothesized that a lateralized HO following RSA would be associated with improved range of motion (ROM), better patient-reported outcomes (PROs), and fewer complications.
A consecutive series of 104 patients (109 shoulders) was retrospectively evaluated. All patients underwent primary RSA by 2 shoulder and elbow fellowship-trained orthopedic surgeons at 2 different centers. Inclusion criteria was a primary RSA with at least 1-year follow-up. All patients had the HO measured on a preoperative and a postoperative Grashey radiograph, and the change in HO was calculated (ΔHO = HO-HO). A negative value was defined as a medialized HO and a positive value as a lateralized HO. ROM and primary outcomes, including forward elevation (FE), external rotation (ER), internal rotation (IR), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, were collected. Complications and revisions were also reported.
The mean age was 72 years with a mean follow-up of 22.3 months. The average FE (92° vs. 148°), ER (34° vs. 44°), SSV (35% vs. 87%), and ASES score (37.2 vs. 81.2) increased significantly (all P < .01) compared with preoperative values. The HO was medialized postoperatively in 63 shoulders and lateralized in 46 shoulders. No statistically significant differences in the mean values for postoperative FE (147° vs. 146°, P = .892), ER (43° vs. 45°, P = .582), IR (L3 vs. L3, P = .852), SSV (88% vs. 85%, P = .476), and ASES score (81.3 vs. 81.1, P = .961) were found between the groups. However, there was significantly more improvement in ER in the lateralized HO cohort than the medialized cohort (16° vs. 7°, P = .033). Six shoulders, 5 medialized and 1 lateralized HO, demonstrated scapular notching and remained asymptomatic. Five shoulders, 4 medialized and 1 lateralized HO, experienced at least 1 instability incident, and 2 shoulders with medialized HO had an acromion/scapular spine fracture. Overall, 2 shoulders with medialized HO underwent revision surgery because of instability.
Although RSA provides significant improvement in ROM and PROs regardless of postoperative HO, restoring baseline HO or lateralization beyond baseline may be favorable for improving ER and decreasing complications following RSA.
格拉蒙特（Grammont）式反肩置换术（RSA）依赖于肩旋转中心的内移和下移。最近，外移设计越来越受欢迎。然而，外移的程度仍然是一个有争议的话题。本研究的目的是分析 RSA 术后肱骨偏移（HO）的变化与结果和并发症之间的关系。我们假设 RSA 术后 HO 的外移与更好的关节活动度（ROM）、更好的患者报告结果（PROs）和更少的并发症有关。
回顾性分析了 104 例（109 肩）连续患者。所有患者均由 2 名经过肩肘 fellowship培训的骨科医生在 2 家不同的中心进行初次 RSA。纳入标准为初次 RSA 且随访时间至少 1 年。所有患者均在术前和术后 Grashey 射线照相中测量 HO，并计算 HO 的变化（ΔHO=HO-HO）。负值定义为内移 HO，正值定义为外移 HO。收集 ROM 和主要结局指标，包括前屈活动度（FE）、外展活动度（ER）、内旋活动度（IR）、主观肩部价值（SSV）和美国肩肘外科医生协会（ASES）标准肩部评估表（ASES）评分。还报告了并发症和翻修情况。
平均年龄为 72 岁，平均随访时间为 22.3 个月。FE（92° vs. 148°）、ER（34° vs. 44°）、SSV（35% vs. 87%）和 ASES 评分（37.2 vs. 81.2）均显著增加（均 P<.01），与术前相比。术后 63 例 HO 内移，46 例 HO 外移。术后 FE（147° vs. 146°，P=.892）、ER（43° vs. 45°，P=.582）、IR（L3 vs. L3，P=.852）、SSV（88% vs. 85%，P=.476）和 ASES 评分（81.3 vs. 81.1，P=.961）的均值在组间无统计学差异。然而，外移 HO 组的 ER 改善程度显著大于内移 HO 组（16° vs. 7°，P=.033）。6 例，5 例内移 HO，1 例外移 HO，出现肩胛切迹且无症状。5 例，4 例内移 HO，1 例外移 HO，至少发生 1 次不稳定事件，2 例内移 HO 出现肩峰/肩胛冈骨折。总体而言，由于不稳定，2 例内移 HO 接受了翻修手术。
尽管 RSA 可显著改善 ROM 和 PROs，但无论术后 HO 如何，恢复基线 HO 或超过基线的外移可能有利于改善 ER，并减少 RSA 后的并发症。
