Noschajew Emil, Rittenschober Felix, Kindermann Harald, Ortmaier Reinhold
Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria.
Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, Campus 4400 Steyr, 4600 Wels, Austria.
J Clin Med. 2022 Oct 17;11(20):6107. doi: 10.3390/jcm11206107.
Background: Glenoid wear is a common complication of anatomical total shoulder arthroplasty (aTSA) with a metal-backed glenoid (MBG), and the clinical and radiological results of historical implants are poor. The aim of this work was to evaluate the clinical and radiological results of 25 participants as well as the longevity after implantation of an anatomic shoulder prosthesis with a recent, modular cementless flat metal-backed glenoid component after a mean follow-up of 5.7 years. Methods: Clinically, the Simple Shoulder Test (SST), UCLA Activity Score (UCLA), and Constant Murley Score (CMS) were evaluated. Radiographically, the radiolucent lines (RLs), humeral head migration (HHM), and lateral glenohumeral offset (LGHO) were assessed. Survival was calculated with Kaplan−Meier curves and life-table analysis. Results: The mean CMS at follow-up was 46.2 points (range: 14−77; SD: 19.5). In terms of the SST score, the average value was 6.5 points (range: 1−10; SD: 3.5). The UCLA activity score showed a mean value of 5.9 points (range: 1−9; SD: 2.1). There were 17 revisions after a mean follow-up of 68.2 months (range: 1.8−119.6; SD: 27.9). HHM occurred in every patient, with a mean measurement of 6.4 mm (range: 0.5−13.4; SD: 3.9; p < 0.0001). The mean LGHO between the initial postoperative and follow-up images was 2.6 mm (range: 0−4.0; SD: 1.5; p < 0.0001). RLs were found in 22 patients (88%) around the glenoid and in 21 patients (84%) around the humeral head prosthesis. Conclusion: The clinical and radiographic outcomes after metal-backed glenoids were poor at 2.2 to 8.4 years of follow-up. We determined devastating survival in the majority of cases (68%), with mostly inlay wear (71%) as the main reason that led to revision surgery. The use of metalback genoids cannot be recommended based on the data of this study.
盂肱关节磨损是解剖型全肩关节置换术（aTSA）采用金属背衬盂肱关节（MBG）时常见的并发症，既往植入物的临床和影像学结果较差。本研究的目的是评估25名参与者的临床和影像学结果，以及在平均随访5.7年后植入带有新型模块化非骨水泥扁平金属背衬盂肱关节组件的解剖型肩关节假体后的使用寿命。方法：临床上，评估简单肩关节测试（SST）、加州大学洛杉矶分校活动评分（UCLA）和常数默里评分（CMS）。影像学上，评估透光线（RLs）、肱骨头移位（HHM）和盂肱关节外侧偏移（LGHO）。采用Kaplan-Meier曲线和寿命表分析计算生存率。结果：随访时CMS的平均值为46.2分（范围：14-77；标准差：19.5）。就SST评分而言，平均值为6.5分（范围：1-10；标准差：3.5）。UCLA活动评分为5.9分（范围：1-9；标准差：2.1）。平均随访68.2个月（范围：1.8-119.6；标准差：27.9）后有17例翻修手术。每位患者均出现肱骨头移位，平均移位量为6.4 mm（范围：0.5-13.4；标准差：3.9；p<0.0001）。术后初始影像与随访影像之间的平均盂肱关节外侧偏移为2.6 mm（范围：0-4.0；标准差：1.5；p<0.0001）。在22例患者（88%）的盂肱关节周围和21例患者（84%）的肱骨头假体周围发现了透光线。结论：在随访2.2至8.年时，金属背衬盂肱关节的临床和影像学结果较差。我们确定大多数病例（68%）的生存率极低，主要是镶嵌磨损（71%）作为导致翻修手术的主要原因。基于本研究的数据，不建议使用金属背衬盂肱关节。
