Testa Edward J, Albright J Alex, Lemme Nicholas J, Molla Vadim, McCrae Brian, Daniels Alan H, Paxton E Scott
From the Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI (Testa, Lemme, Molla, Daniels, and Paxton), and the Brown University, Warren Alpert School of Medicine, Providence, RI (Albright and McCrae).
J Am Acad Orthop Surg. 2023 May 1;31(9):e473-e480. doi: 10.5435/JAAOS-D-22-00752. Epub 2023 Jan 24.
As rates of anatomic and reverse total shoulder arthroplasty (SA) continue to grow, an increase in the number of osteoporotic patients undergoing SA, including those who have sustained prior fragility fractures, is expected. The purpose of this study was to examine short-term, implant-related complication rates and secondary fragility fractures after SA in patients with and without a history of fragility fractures.
A propensity score-matched retrospective cohort study was done using the PearlDiver database to characterize the effect of antecedent fragility fractures in short-term complications after SA. Rates of revision SA, periprosthetic fractures, infection, and postoperative fragility fractures were evaluated using multivariate logistic regression analysis. Risks of these complications were also studied in patients with and without preoperative osteoporosis treatment. Statistical significance was set at P < 0.05.
A total of 91,212 SA patients were identified, with 13,050 (14.3%) experiencing a fragility fracture within the 3 years before SA. Two years after SA, there were increased odds of periprosthetic fracture (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.68 to 2.99), fragility fracture (OR 9.11, 95% CI 8.43 to 9.85), deep infection (OR 1.68, 95% CI 1.34 to 2.12), and all-cause revision SA (OR 1.68, 95% CI 1.44 to 1.96) within those patients who had experienced a fragility fracture within 3 years before their SA. Patients who were treated for osteoporosis with bisphosphonates and/or vitamin D supplementation before their SA had similar rates of postoperative periprosthetic fractures, fragility fractures, and all-cause revision SA to those who did not receive pharmacologic treatment.
Sustaining a fragility fracture before SA portends substantial postoperative risk of periprosthetic fractures, infection, subsequent fragility fractures, and all-cause revision SA at the 2-year postoperative period. Pharmacotherapy did not markedly decrease the rate of these complications. These results are important for surgeons counseling patients who have experienced prior fragility fractures on the risks of SA.
随着解剖型和反向全肩关节置换术（SA）的手术率持续上升，预计接受SA的骨质疏松患者数量将会增加，包括那些既往发生过脆性骨折的患者。本研究的目的是调查有或无脆性骨折病史的患者在SA术后的短期、与植入物相关的并发症发生率以及继发性脆性骨折情况。
使用PearlDiver数据库进行了一项倾向评分匹配的回顾性队列研究，以描述既往脆性骨折对SA术后短期并发症的影响。采用多因素逻辑回归分析评估翻修SA、假体周围骨折、感染和术后脆性骨折的发生率。还研究了术前接受和未接受骨质疏松治疗的患者发生这些并发症的风险。设定P < 0.05为具有统计学意义。
共识别出91,212例SA患者，其中13,050例（14.3%）在SA术前3年内发生过脆性骨折。SA术后两年，术前3年内发生过脆性骨折的患者发生假体周围骨折（比值比[OR] 2.24，95%置信区间[CI] 1.68至2.99）、脆性骨折（OR 9.11，95% CI 8.43至9.85）、深部感染（OR 1.68，95% CI 1.34至2.12）和全因翻修SA（OR 1.68，95% CI （此处原文有误，应为1.44至1.96））的几率增加。术前接受双膦酸盐和/或维生素D补充剂治疗骨质疏松的患者，其术后假体周围骨折、脆性骨折和全因翻修SA的发生率与未接受药物治疗的患者相似。
SA术前发生脆性骨折预示着术后2年内发生假体周围骨折、感染、继发性脆性骨折和全因翻修SA的风险大幅增加。药物治疗并未显著降低这些并发症的发生率。这些结果对于外科医生向有脆性骨折病史的患者咨询SA风险具有重要意义。
