Department of orthopedic, Shenzhen University First Affiliated Hospital: Shenzhen Second People's Hospital, Shenzhen, Guangdong, China.
Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Medicine (Baltimore). 2022 Aug 12;101(32):e29896. doi: 10.1097/MD.0000000000029896.
Osteoarthritis (OA) is a common shoulder disorder that impacts shoulder functions. Shoulder arthroplasty is often required to restore function and quality of life. Reverse total shoulder arthroplasty (RSA), which was originally designed mainly for irreparable rotator cuff damage, has gained popularity in recent years for the treatment of advanced shoulder OA instead of the clinically standard total shoulder arthroplasty (TSA). However, this RSA has some nonnegligible flaws such as higher complications rate and economic cost, not mention the following problems caused by irreversible physical structural damage. Therefore, the employment of RSA needs to be carefully considered. This study aimed to compare TSA and RSA in OA patients with or without rotator cuff damage to better guide clinical decision making. We believe the radical use of RSA in patients without rotator cuff deficiency may cause more harm than good. We queried the Nationwide Inpatient Sample (NIS) database from 2011 to 2014 to collect information on OA patients who received TSA and RSA. Patients were divided into 2 groups of comparison according to the presence of rotator cuff deficiency and matched with propensity score analysis. A total of 57,156 shoulder arthroplasties were identified. RSA patients in the rotator cuff deficiency group had significant higher transfusion rates and longer hospital stays. RSA patients without rotator cuff deficiency had a statistically significantly higher number of implant-related mechanical complications, acute upper respiratory infections and postoperative pain. Overall, RSA incurred higher costs in both groups. For OA patients with rotator cuff deficiencies, RSA has its benefits as complication rates were comparable to TSA. For those patients without rotator cuff deficiencies, the use of RSA should be reconsidered as there were more complications with higher severity.
骨关节炎（OA）是一种常见的肩部疾病，会影响肩部功能。为了恢复功能和生活质量，通常需要进行肩部关节置换术。近年来，反向全肩关节置换术（RSA）越来越受欢迎，它最初主要是为了治疗不可修复的肩袖损伤而设计的，现在已经被用于治疗晚期肩关节炎，而不是传统的全肩关节置换术（TSA）。然而，这种 RSA 存在一些不可忽视的缺陷，例如更高的并发症发生率和经济成本，更别提不可逆的物理结构损伤带来的问题。因此，RSA 的应用需要慎重考虑。本研究旨在比较肩袖损伤和无肩袖损伤的 OA 患者行 TSA 和 RSA 的效果，以便更好地指导临床决策。我们认为，在没有肩袖缺损的患者中激进地使用 RSA 可能弊大于利。我们查询了 2011 年至 2014 年的全国住院患者样本（NIS）数据库，以收集接受 TSA 和 RSA 的 OA 患者的信息。根据是否存在肩袖缺损，患者被分为两组进行比较，并采用倾向评分匹配分析。共确定了 57156 例肩关节置换术。在肩袖缺损组中，RSA 患者的输血率和住院时间明显更长。在无肩袖缺损组中，RSA 患者的与植入物相关的机械并发症、急性上呼吸道感染和术后疼痛的数量明显更多。总体而言，两组 RSA 的成本都更高。对于有肩袖缺损的 OA 患者，RSA 的并发症发生率与 TSA 相当，因此具有一定的优势。对于那些没有肩袖缺损的患者，应该重新考虑使用 RSA，因为 RSA 会导致更严重的并发症。
