Singh Jagdev Balraj, McGrath Jonathan, Cole Alex, Gomaa Abdul-Rahman, Chong Han Hong, Singh Harvinder Pal
University Hospital of Leicester NHS Trust, Leicester, UK.
Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK.
J Shoulder Elbow Surg. 2022 Dec;31(12):2657-2670. doi: 10.1016/j.jse.2022.07.012. Epub 2022 Aug 24.
Glenohumeral arthritis is a degenerative disease of the shoulder joint. There is limited evidence in the literature in superiority of outcomes between total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) for patients when the rotator cuff is intact. The purpose of this systematic review was to compare patient-reported outcome measures (PROMs) and rate of complication between these 2 interventions in patients with primary glenohumeral arthritis and an intact rotator cuff. Previous systematic reviews have focused only on results from randomized controlled trials, demonstrating mixed outcomes in PROMs and no difference in postoperative complications or rate of revision. Our study is the first, to our knowledge, to assess all comparative studies including prospective and retrospective observational studies, assessing a combined 1317 patients. Using the ratio of means, data from different PROMs were pooled to analyze and compare the total combined relative effect change following intervention.
We undertook literature review of the reference databases until March 2021. We included randomized controlled trials in addition to comparative observational studies and case series (more than 10 patients). Study participants were adults who had primary glenohumeral arthritis with an intact rotator cuff. Meta-analysis was performed by the ratio of means for PROMs and risk ratio for revision and complication data.
Comparing clinical outcome of TSA against HA from 10 studies, meta-analyses using ratio of means demonstrated an 8% significantly improved relative increase in the postoperative PROMs in the TSA cohort (ratio of means 1.08, 95% confidence interval [CI] 0.04-1.12, P < .01). The TSA cohort additionally demonstrated a significantly lower revision rate (relative risk 1.84, 95% CI 1.05-3.24, P = .03). Although the risk of complication was nonsignificant, pooling revision and complications data revealed a 2-fold increased risk in the HA group compared with TSA (relative risk 2.09, 95% CI 1.17-3.74, P = .01).
In patients with primary glenohumeral osteoarthritis with an intact rotator cuff, TSA is favored to HA in terms of clinical outcome, risk of revision surgery, and postoperative complications.
盂肱关节炎是一种肩关节退行性疾病。对于肩袖完整的患者，全肩关节置换术（TSA）和半肩关节置换术（HA）在疗效上的优越性，文献中的证据有限。本系统评价的目的是比较原发性盂肱关节炎且肩袖完整的患者接受这两种手术干预后的患者报告结局指标（PROMs）和并发症发生率。以往的系统评价仅关注随机对照试验的结果，结果显示PROMs的结果不一，术后并发症或翻修率无差异。据我们所知，我们的研究是首次评估所有比较性研究，包括前瞻性和回顾性观察性研究，共评估了1317例患者。使用均值比，汇总来自不同PROMs的数据，以分析和比较干预后总的相对效应变化。
我们对参考数据库进行文献检索，截至2021年3月。除了比较性观察性研究和病例系列（超过10例患者）外，我们还纳入了随机对照试验。研究参与者为患有原发性盂肱关节炎且肩袖完整的成年人。通过PROMs的均值比以及翻修和并发症数据的风险比进行荟萃分析。
比较10项研究中TSA与HA的临床结局，使用均值比进行的荟萃分析表明，TSA队列术后PROMs的相对增加显著提高了8%（均值比1.08，95%置信区间[CI]0.04 - 1.12，P <.01）。TSA队列的翻修率也显著更低（相对风险1.84，95% CI 1.05 - 3.24，P = 0.03）。虽然并发症风险无统计学意义，但汇总翻修和并发症数据显示，与TSA相比，HA组的风险增加了2倍（相对风险2.09，95% CI 1.17 - 3.74，P = 0.01）。
对于原发性盂肱骨关节炎且肩袖完整的患者，在临床结局、翻修手术风险和术后并发症方面，TSA优于HA。
