Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
J Shoulder Elbow Surg. 2023 Mar;32(3):573-580. doi: 10.1016/j.jse.2022.08.024. Epub 2022 Oct 4.
End-stage glenohumeral joint arthritis is common in patients with inflammatory arthritis. Reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (TSA) are both indicated in this setting. RSA is often considered based on the impacts of long-standing inflammatory arthritis including glenoid and humeral bone erosion and rotator cuff insufficiency. However, acromial and scapular spine fractures following RSA have been reported more commonly in these patients, which can have a significant impact on outcomes. Currently, no study has directly compared the efficacy and complication rates of RSA vs. TSA in patients with inflammatory arthritis. This study aimed to investigate differences in clinical outcomes and complications in patients undergoing RSA vs. TSA with glenohumeral inflammatory arthritis.
We performed a retrospective review of 86 patients with inflammatory arthritis treated with primary RSA (n = 43) or TSA (n = 43) with a minimum of 2 years' follow-up. American Shoulder and Elbow Surgeons scores, Simple Shoulder Test scores, visual analog scale scores for pain and function, active range of motion, and patient self-ratings of upper-extremity normality (Subjective Assessment of Normal Evaluation [SANE]) were collected preoperatively and at minimum 2-year follow-up. Radiographic classification of preoperative glenoid and humeral bone loss was performed, and postoperative complications were observed. Revision and complication details were compared.
The study cohort had an average age of 72.1 years (range, 31-92 years) and average follow-up period of 51.6 months (range, 22-159 months). Both the RSA and TSA cohorts demonstrated improvements in patient-reported outcome measures and ranges of motion; however, patients treated with TSA showed a greater postoperative final Simple Shoulder Test score (P < .001), visual analog scale score for function (P = .0347), active elevation (P = .0331), active external rotation (P < .001), active internal rotation (P = .005), and Single Assessment Numeric Evaluation (SANE) score (P = .0161). Analysis of complication rates demonstrated no statistically significant difference between cohorts. Four acromial fractures occurred in the RSA group. When RSA patients who sustained acromial fractures were removed from the analysis, there were minimal differences in outcomes between the RSA and TSA cohorts.
TSA in patients with inflammatory arthritis leads to improved clinical outcomes but higher early revision rates when compared with RSA. RSA outcomes are negatively impacted by a high rate of postoperative acromial fractures.
终末期盂肱关节关节炎在炎症性关节炎患者中很常见。反式肩关节置换术（RSA）和解剖全肩关节置换术（TSA）在这种情况下都适用。RSA 通常是基于长期炎症性关节炎的影响而考虑的，包括肩胛盂和肱骨的骨侵蚀以及肩袖的不足。然而，在接受 RSA 治疗的患者中，更常见到 RSA 后发生肩峰和肩胛脊柱骨折，这会对结果产生重大影响。目前，尚无研究直接比较 RSA 与 TSA 在炎症性关节炎患者中的疗效和并发症发生率。本研究旨在探讨 RSA 与 TSA 治疗盂肱炎性关节炎患者的临床疗效和并发症的差异。
我们对 86 例接受初次 RSA（n=43）或 TSA（n=43）治疗的炎症性关节炎患者进行了回顾性研究，随访时间至少为 2 年。收集术前和至少 2 年随访时的美国肩肘外科评分（ASES）、简单肩测试评分（Simple Shoulder Test score）、疼痛和功能视觉模拟评分（visual analog scale score）、主动活动范围以及上肢正常的患者自我评分（Subjective Assessment of Normal Evaluation[SANE]）。对术前肩胛盂和肱骨骨丢失的放射学分类进行了评估，并观察了术后并发症。比较了翻修和并发症的细节。
该研究队列的平均年龄为 72.1 岁（范围，31-92 岁），平均随访时间为 51.6 个月（范围，22-159 个月）。RSA 和 TSA 两组患者的患者报告的结果测量和活动范围均有所改善；然而，接受 TSA 治疗的患者术后最终 Simple Shoulder Test 评分（P<.001）、功能视觉模拟评分（P=.0347）、主动抬高（P=.0331）、主动外旋（P<.001）、主动内旋（P=.005）和单评估数字评估（SANE）评分（P=.0161）更高。并发症发生率分析表明两组之间无统计学显著差异。RSA 组有 4 例肩峰骨折。当从分析中去除 RSA 组发生肩峰骨折的患者后，RSA 和 TSA 两组之间的结果差异很小。
与 RSA 相比，炎症性关节炎患者接受 TSA 治疗可改善临床疗效，但早期翻修率更高。RSA 结果因术后肩峰骨折发生率高而受到负面影响。
