Monroe Emily J, Hardy Richard, Holmquist James, Brand Jefferson C
Heartland Orthopedic Specialists, 111 17th Ave E, Ste 101, Alexandria, MN, 56308, USA.
Curr Rev Musculoskelet Med. 2022 Jun;15(3):180-186. doi: 10.1007/s12178-022-09753-8. Epub 2022 May 5.
Rates of obesity and reverse total shoulder arthroplasty (rTSA) in the USA have both escalated with time. Obese patients experience arthritis at higher rates than normal weight patients; therefore, these numbers go hand in hand. Obesity has been correlated with health comorbidities such as anxiety, cardiovascular disease, diabetes, and metabolic syndrome as well as poorer outcomes and higher complication rates following lower extremity arthroplasty. The current review investigates these comorbidities as they relate to obese patients undergoing rTSA.
Functional outcomes are similar to normal weight counterparts. Although longer operative times and a large soft tissue envelope would intuitively predispose these patients to higher risk for infection or other complications, this has not been reliably demonstrated. Technical considerations and awareness of potential risks in the obese patient demographic may aid the surgeon in preoperative planning and counseling of their patient. Obese patients undergoing rTSA have been shown to have higher risks specifically for infection, revision, and medical complications; however, this has not been consistently demonstrated in the single surgeon series where, more often, no difference in these metrics has been found. Outcomes measures and satisfaction are reliably improved, even when considering superobese patients, and majority of studies find their improvements and absolute values to be in line with their normal weight counterparts. Thus, rTSA does not seem to carry the same level of adverse risk associated with lower joint arthroplasty but potential for higher risk still bears consideration when counseling obese patients. Attention to factors that may negatively affect prosthesis positioning may optimize retention rates and limit early failure.
在美国，肥胖率和反式全肩关节置换术（rTSA）的发生率均随时间上升。肥胖患者患关节炎的几率高于正常体重患者；因此，这两个数字是相伴上升的。肥胖与焦虑、心血管疾病、糖尿病和代谢综合征等健康合并症相关，也与下肢关节置换术后较差的预后和较高的并发症发生率相关。本综述研究这些合并症与接受rTSA的肥胖患者之间的关系。
功能结果与正常体重患者相似。尽管手术时间较长和软组织覆盖范围较大直观上会使这些患者更容易发生感染或其他并发症，但这尚未得到可靠证实。对肥胖患者群体的技术考量和潜在风险的认识可能有助于外科医生在术前为患者进行规划和咨询。接受rTSA的肥胖患者已被证明在感染、翻修和医疗并发症方面有更高的风险；然而，在单一外科医生的系列研究中，这一点并未得到一致证实，在这些研究中，这些指标往往没有差异。即使考虑到超级肥胖患者，结果指标和满意度也能得到可靠改善，大多数研究发现他们的改善情况和绝对值与正常体重患者相当。因此，rTSA似乎不像下肢关节置换术那样具有相同程度的不良风险，但在为肥胖患者提供咨询时，仍需考虑较高风险的可能性。关注可能对假体定位产生负面影响的因素可能会优化保留率并限制早期失败。
