Southern Maryland Orthopaedic and Sports Medicine Center, Leonardtown, MD, USA; Georgetown University School of Medicine, Washington, DC, USA.
University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
J Shoulder Elbow Surg. 2023 Jun;32(6):1222-1230. doi: 10.1016/j.jse.2022.11.021. Epub 2022 Dec 28.
BACKGROUND: Anatomic total shoulder arthroplasty (aTSA) is a successful and reproducible treatment for patients with painful glenohumeral arthritis. However, long-term outcomes using traditional onlay glenoid components have been tempered by glenoid loosening. Inset components have been proposed to minimize glenoid loosening by reducing edge-loading and opposite-edge lift-off forces with humeral translation. Successful short- and long-term outcomes have been reported while using inset glenoid implants. The current study is the largest study presenting a minimum of 2-year follow-up data following aTSA with an all-polyethylene inset glenoid component (Shoulder Innovations, Holland, MI, USA). METHODS: A dual center, retrospective review of patients undergoing aTSA using an Inset glenoid component by 2 fellowship-trained shoulder surgeons at 2 separate institutions from August, 2016, to August, 2019, was performed. Minimum follow-up was 2 years. Range of motion (ROM), visual analog scale (VAS) pain scores, Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) scores were obtained. Radiographic outcomes, including central peg lucency and glenoid loosening, were assessed by 3 independent reviewers on the postoperative Grashey and axillary radiographs obtained at the final follow-up. RESULTS: Seventy-five shoulders were included for the final analysis. The mean age of the entire cohort was 64 (±11.4) years. Twenty-one (28%) glenoids were type A1, 10 (13.3%) were type A2, 13 (17.3%) were type B1, 22 (29.3%) were type B2, 6 (8%) were type B3, and 3 (4%) were type D. At a minimum follow-up of 24 months (mean: 28.7 months), a significant improvement in ROM in all planes was observed. Significant improvements in VAS (5.1-0.9, P < .001), SANE (39.5-91.2, P < .001), and ASES (43.7-86.6, P < .001) scores were observed. There were 4 (5.3%) cases of central peg lucency about the inset glenoid component and one (1.3%) case of glenoid loosening. No revisions were performed for glenoid loosening. CONCLUSION: At a minimum of 2 years postoperatively, there were significant improvements in ROM, VAS, SANE, and ASES scores with very low rates of central peg lucency and glenoid loosening in patients undergoing aTSA with an inset glenoid component. Further work is needed to determine the long-term benefit of this novel implant.
背景：解剖型全肩关节置换术（aTSA）是一种治疗肩痛性肩关节炎的成功且可重复的治疗方法。然而，传统的上置式肩胛盂假体的长期效果受到肩胛盂松动的影响。嵌入式假体通过减少肱骨平移时的边缘负荷和对侧边缘抬起力来减少肩胛盂松动，从而被认为可以最小化肩胛盂松动。使用嵌入式肩胛盂植入物已报告了短期和长期的成功结果。目前的研究是报告使用全聚乙烯嵌入式肩胛盂假体（密歇根州霍兰的 Shoulder Innovations，美国）进行 aTSA 后至少 2 年随访数据的最大研究。
方法：对 2016 年 8 月至 2019 年 8 月在 2 个独立机构由 2 名经过 fellowship 培训的肩部外科医生进行的 aTSA 使用嵌入式肩胛盂组件的双中心回顾性研究。最小随访时间为 2 年。获得了运动范围（ROM）、视觉模拟量表（VAS）疼痛评分、单一评估数字评估（SANE）和美国肩肘外科医生（ASES）评分。通过 3 名独立的观察者在术后 Grashey 和腋位 X 线片上评估了放射学结果，包括中心钉的透亮和肩胛盂的松动，这些 X 线片是在最后一次随访时获得的。
结果：75 个肩部被纳入最终分析。整个队列的平均年龄为 64（±11.4）岁。21 个（28%）肩胛盂为 A1 型，10 个（13.3%）为 A2 型，13 个（17.3%）为 B1 型，22 个（29.3%）为 B2 型，6 个（8%）为 B3 型，3 个（4%）为 D 型。在至少 24 个月（平均：28.7 个月）的随访中，所有平面的 ROM 均有显著改善。VAS（5.1-0.9，P<.001）、SANE（39.5-91.2，P<.001）和 ASES（43.7-86.6，P<.001）评分均有显著改善。有 4 例（5.3%）出现中心钉透亮，1 例（1.3%）出现肩胛盂松动。没有因肩胛盂松动而进行翻修。
结论：在接受 aTSA 联合嵌入式肩胛盂假体治疗的患者中，至少 2 年后，ROM、VAS、SANE 和 ASES 评分有显著改善，中心钉透亮和肩胛盂松动的发生率非常低。需要进一步研究来确定这种新型植入物的长期益处。
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