Cutler Holt S, DeClercq Josh, Ayers Gregory D, Serbin Philip, Jain Nitin, Khazzam Michael
From the Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cutler, Serbin, and Khazzam), the Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN (DeClercq and Ayers), and the Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX (Jain).
J Am Acad Orthop Surg. 2023 Jan 1;31(1):17-25. doi: 10.5435/JAAOS-D-21-01090. Epub 2022 Nov 1.
The objective of this study was to determine the survivorship of anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) over a medium-term follow-up in a large population-based sample and to identify potential risk factors for revision surgery.
The State Inpatient Database from the Healthcare Cost and Utilization Project was used to identify patients who underwent aTSA or rTSA from 2011 through 2015 using ICD9 codes. We modeled the primary outcome of time to revision or arthroplasty using the Cox proportional hazards model. The predictors of revision surgery in the model include aTSA versus rTSA, indication for surgery, age, sex, race, urban versus rural residence, hospital length of stay zip code-based income quartile classification, and Elixhauser comorbidity readmission score.
Among 43,990 patients in this study, 1,141 (4.0%) underwent revision or implant removal over the 4-year study period. The median age was 71 years, and 57% of patients were female. Indications for the index surgery included primary osteoarthritis (75.2%), cuff tear (8.5%), acute fracture (7.0%), malunion/nonunion (1.4%), and other (7.8%). Among these indications for surgery, the risk of revision or removal was greatest in patients who underwent the primary procedure for malunion/nonunion (hazard ratio [HR] 2.39, 95% confidence interval [CI] 1.69 to 3.39) compared with the reference of primary osteoarthritis. Male patients who underwent aTSA were less likely to need revision surgery than male patients who underwent rTSA (HR: 0.59, 95% CI 0.49 to 0.71), and the opposite relationship was observed in female patients (HR: 1.41, 95% CI 1.18 to 1.69). Age, length of stay, and Elixhauser comorbidity score were predictive of revision surgery (P < 0.0001, P = 0.0005, P < 0.0001, respectively), whereas race, urban versus rural, and zip code-based income quartile were not.
aTSA and rTSA showed excellent 4-year survivorship of 96.0% in a large population-based sample. aTSA and rTSA survivorships were similar at the 4-year follow-up.
本研究的目的是在一个基于人群的大样本中，通过中期随访确定解剖型全肩关节置换术（aTSA）和反式全肩关节置换术（rTSA）的假体生存率，并确定翻修手术的潜在风险因素。
利用医疗成本和利用项目的国家住院患者数据库，使用ICD9编码识别2011年至2015年期间接受aTSA或rTSA手术的患者。我们使用Cox比例风险模型对翻修或再次置换的时间这一主要结局进行建模。模型中翻修手术的预测因素包括aTSA与rTSA、手术指征、年龄、性别、种族、城乡居住地、基于邮政编码的收入四分位数分类以及Elixhauser合并症再入院评分。
在本研究的43990例患者中，1141例（4.0%）在4年的研究期间接受了翻修手术或植入物取出手术。中位年龄为71岁，57%的患者为女性。初次手术的指征包括原发性骨关节炎（75.2%）、肩袖撕裂（8.5%）、急性骨折（7.0%）、畸形愈合/不愈合（1.4%）以及其他（7.8%）。在这些手术指征中，与原发性骨关节炎这一参照组相比，接受初次手术治疗畸形愈合/不愈合的患者翻修或取出的风险最大（风险比[HR]2.39，95%置信区间[CI]1.69至3.39）。接受aTSA的男性患者比接受rTSA的男性患者需要翻修手术的可能性更小（HR：0.59，95%CI 0.49至0.71），而在女性患者中观察到相反的关系（HR：1.41，95%CI 1.18至1.69）。年龄、住院时间和Elixhauser合并症评分可预测翻修手术（P分别<0.0001、P = 0.0005、P<0.0001），而种族、城乡以及基于邮政编码的收入四分位数则不然。
在一个基于人群的大样本中，aTSA和rTSA显示出优异的4年假体生存率，为96.0%。在4年随访时，aTSA和rTSA的生存率相似。
