Chelli Mikaël, Boileau Pascal, Domos Peter, Clavert Philippe, Berhouet Julien, Collin Philippe, Walch Gilles, Favard Luc
University Institute of Locomotion and Sports, University Hospital of Nice, 06000 Nice, France.
Barnet and Chase Farm Hospitals, Royal Free London NHS Foundation Trust, Barnet EN5 3DJ, UK.
J Clin Med. 2022 May 10;11(10):2677. doi: 10.3390/jcm11102677.
Background. The indications for reverse shoulder arthroplasty (RSA) have been widely expanded, but only a few studies report the long-term survival of these implants. Our objective was to report the long-term survivorship of a large series of RSAs implanted for different etiologies. Methods. A retrospective multicenter study including all the RSAs was performed in six shoulder-specialized centers with at least 2 years of follow up. We reviewed 1611 RSAs, operated between 1993 and 2010, including 497 cuff-tear arthropathies (CTA), 239 revision RSAs, 188 massive cuff tears (MCT), 185 fracture sequelae (FS), 183 failed previous cuff repairs (FCR), and 142 primary osteoarthritis (POA). The mean follow-up was 5.6 ± 3.9 years (range 2−20). Results. Overall, 266 RSAs (16.5%) had at least one complication leading to 64 reoperations (4.0%) and 110 revision surgeries (6.8%). The most frequent complications were infection (3.8%), instability (2.8%), and humerus-related complications (2.8%). At 10 years, the survival without revision surgery was 91.0% in primary RSAs and 80.9% in revision RSAs for failed arthroplasty (p < 0.001). In the primary RSA group, MCT and FCR led to 10-year survivals for over 95% but fracture sequelae and tumors had the lowest 10-year survivals (83.9% and 53.1%). Younger patients had a lower 10-year survival. In revision RSAs, male patients had a significantly lower survival than females (72.3% vs. 84.5% at 10 years, p = 0.020). Discussion. Primary RSA for cuff-deficient shoulders or POA leads to a high 10-year survival, but revision RSA or primary RSA for FS and tumors are at high-risk for revision. Surgeons should be aware of high rates of complications and lower survival rates of RSA in younger patients, in males, and in RSAs for revision surgery.
背景。反肩关节置换术（RSA）的适应证已被广泛扩展，但仅有少数研究报道了这些植入物的长期生存率。我们的目的是报告大量因不同病因植入的RSA的长期生存率。方法。在六个肩关节专科中心进行了一项回顾性多中心研究，纳入所有接受RSA手术且随访至少2年的患者。我们回顾了1993年至2010年间手术的1611例RSA，包括497例肩袖撕裂性关节病（CTA）、239例翻修RSA、188例巨大肩袖撕裂（MCT）、185例骨折后遗症（FS）、183例既往肩袖修复失败（FCR）以及142例原发性骨关节炎（POA）。平均随访时间为5.6±3.9年（范围2 - 20年）。结果。总体而言，266例RSA（16.5%）发生了至少一种并发症，导致64例再次手术（4.0%）和110例翻修手术（6.8%）。最常见的并发症为感染（3.8%）、不稳定（2.8%）以及与肱骨相关的并发症（2.8%）。在10年时，初次RSA未进行翻修手术的生存率为91.0%，翻修RSA治疗失败关节置换术的生存率为80.9%（p < 0.001）。在初次RSA组中，MCT和FCR的10年生存率超过95%，但骨折后遗症和肿瘤的10年生存率最低（分别为83.9%和53.1%）。年轻患者的10年生存率较低。在翻修RSA中，男性患者的生存率显著低于女性（10年时分别为72.3%和84.5%，p = 0.020）。讨论。对于肩袖缺失性肩关节或POA的初次RSA可获得较高的10年生存率，但翻修RSA或针对FS和肿瘤的初次RSA翻修风险较高。外科医生应意识到年轻患者、男性患者以及翻修手术的RSA并发症发生率高且生存率较低。
