Levins James, Molla Vadim, Adkins Jacob, Molino Janine, Pasarelli Emily, Paxton E Scott, Green Andrew
Division of Shoulder and Elbow Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
J Bone Joint Surg Am. 2023 Apr 5;105(7):509-517. doi: 10.2106/JBJS.22.00650. Epub 2023 Jan 19.
Glenoid component failure is a major concern after anatomic total shoulder arthroplasty (aTSA). Ream and run (RnR) is an alternative procedure that may avoid glenoid-related complications. The purpose of this study was to compare outcomes of RnR versus aTSA in younger patients with advanced glenohumeral osteoarthritis.
This was a retrospective matched-cohort study of 110 patients who underwent aTSA and 57 patients who underwent RnR; patients were <66 years of age and had a minimum of 2 years of follow-up. Propensity matching was performed using 21 preoperative variables. Pre- and postoperative patient-reported outcome measures (PROMs) and health-related quality-of-life (HRQoL) scores, satisfaction with outcome, and revision data were analyzed. Mixed-effects models examined the association of preoperative variables with outcomes.
Thirty-nine patient pairs were matched. All patients were male, with a mean age of 58.6 ± 7.3 years and a mean follow-up 4.4 ± 2.3 years. The aTSA cohort had better final Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) scores. However, in the mixed-effects model analysis, arthroplasty type was not associated with outcome. At 2 years postoperatively, a significantly greater percentage of aTSA patients achieved the substantial clinical benefit (SCB) for the ASES (100% versus 79.2%; p = 0.01) and the minimal clinically important difference (MCID) (89.7% versus 75%; p = 0.02) for the visual analog scale (VAS) for pain. At >5-year follow-up, there were no significant differences between the cohorts in the percentage who achieved the MCID, SCB, or patient acceptable symptom state (PASS) for the ASES, SST, and VAS for pain. Three patients underwent revision arthroplasty for pain after RnR, at a mean of 1.9 ± 1.7 years. Two patients underwent revision arthroplasty for glenoid loosening at 9.2 and 14 years after aTSA.
RnR and aTSA had comparable outcomes in most analyses. The greater early revision rate after RnR should focus attention on optimizing patient selection and postoperative management. Revision for glenoid loosening is a concern among younger and active patients. Longer-term study is needed to better understand the relative benefits and disadvantages of these procedures.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
解剖型全肩关节置换术（aTSA）后盂肱关节组件失败是一个主要问题。扩孔与植入（RnR）是一种替代手术，可能避免与盂肱关节相关的并发症。本研究的目的是比较RnR与aTSA在患有晚期盂肱关节骨关节炎的年轻患者中的疗效。
这是一项回顾性匹配队列研究，纳入110例行aTSA的患者和57例行RnR的患者；患者年龄<66岁，且至少随访2年。使用21个术前变量进行倾向匹配。分析术前和术后患者报告的结局指标（PROMs）、健康相关生活质量（HRQoL）评分、对结局的满意度以及翻修数据。混合效应模型研究术前变量与结局之间的关联。
匹配了39对患者。所有患者均为男性，平均年龄58.6±7.3岁，平均随访4.4±2.3年。aTSA队列的最终简单肩关节测试（SST）和美国肩肘外科医师学会（ASES）评分更高。然而，在混合效应模型分析中，关节置换类型与结局无关。术后2年，aTSA患者中达到ASES显著临床获益（SCB）的比例（100%对79.2%；p = 0.01）以及疼痛视觉模拟量表（VAS）达到最小临床重要差异（MCID）的比例（89.7%对75%；p = 0.02）显著更高。在>5年的随访中，两组在达到ASES、SST和疼痛VAS的MCID、SCB或患者可接受症状状态（PASS）的比例方面没有显著差异。3例患者在RnR后因疼痛接受了翻修关节置换术，平均时间为1.9±1.7年。2例患者在aTSA后9.2年和14年因盂肱关节松动接受了翻修关节置换术。
在大多数分析中，RnR和aTSA的疗效相当。RnR后较高的早期翻修率应促使关注优化患者选择和术后管理。对于年轻且活跃的患者，盂肱关节松动的翻修是一个问题。需要进行长期研究以更好地了解这些手术的相对利弊。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
