Medical University of South Carolina, Charleston, SC, USA.
Exactech, Inc., Gainesville, FL, USA.
J Shoulder Elbow Surg. 2023 Aug;32(8):1584-1593. doi: 10.1016/j.jse.2023.01.010. Epub 2023 Feb 2.
Early reverse total shoulder arthroplasty (rTSA) designs had high failure rates, mainly from loosening of the glenoid baseplate. The purpose of this study was to determine the incidence of aseptic glenoid baseplate loosening after primary rTSA using a contemporary medialized glenoid-lateralized humerus system and identify significant risk factors associated with loosening.
A total of 7162 patients underwent primary rTSA with a single-platform rTSA system between April 2007 and August 2021; of these primary rTSA patients, 3127 with a minimum 2-year follow-up period were identified. Patients with aseptic glenoid baseplate loosening were compared with all other primary rTSA patients without loosening. Univariate and multivariate analyses were performed to compare these cohorts and identify the demographic characteristics, comorbidities, operative parameters, and implant characteristics associated aseptic glenoid loosening after rTSA. Odds ratios (ORs) were calculated for each significant risk factor and for multiple combinations of risk factors.
Irrespective of minimum follow-up, 53 of 7162 primary rTSA shoulders (31 female and 22 male shoulders) experienced aseptic glenoid loosening, for an overall rate of 0.74%. At latest (2-year minimum) follow-up, 30 of 3127 patients experienced aseptic glenoid loosening and showed significantly lower clinical scores, function, and active range of motion and higher pain scores than patients without loosening. Univariate analysis identified rheumatoid arthritis (P = .029; OR, 2.74) and diabetes (P = .028; OR, 1.84) as significant risk factors for aseptic glenoid loosening after rTSA, and multivariate analysis identified Walch glenoid types B2 (P = .002; OR, 4.513) and B3 (P = .002; OR, 14.804), use of expanded lateralized glenospheres (P = .025; OR, 2.57), and use of augmented baseplates (P = .001; OR, 2.50) as significant risk factors.
The incidence of aseptic glenoid baseplate loosening was 0.74% for the evaluated medialized glenoid-lateralized humerus rTSA system. Numerous risk factors for aseptic loosening were identified, including rheumatoid arthritis, diabetes, Walch type B2 and B3 glenoids, posteriorly-superiorly augmented baseplates, and expanded lateralized glenospheres. Finally, analysis of multiple combinations of risk factors identified patients and implant configurations with the greatest risk of aseptic glenoid loosening.
早期反式全肩关节置换术（rTSA）设计的失败率较高，主要是由于肩胛盂基底部松动。本研究旨在使用现代内侧化肩胛盂-外侧化肱骨头系统确定原发性 rTSA 后无菌性肩胛盂基底部松动的发生率，并确定与松动相关的显著危险因素。
2007 年 4 月至 2021 年 8 月期间，共有 7162 例患者接受了原发性 rTSA，其中有 3127 例患者的随访时间至少为 2 年。对患有无菌性肩胛盂基底部松动的原发性 rTSA 患者与所有其他无松动的原发性 rTSA 患者进行比较。对这些队列进行单因素和多因素分析，以确定与 rTSA 后无菌性肩胛盂松动相关的人口统计学特征、合并症、手术参数和植入物特征。对每个显著危险因素和多个危险因素组合计算比值比（OR）。
无论随访时间长短，7162 例原发性 rTSA 肩中有 53 例（31 例女性和 22 例男性）出现无菌性肩胛盂松动，总体发生率为 0.74%。在末次（2 年最低）随访时，3127 例患者中有 30 例出现无菌性肩胛盂松动，与未松动患者相比，临床评分、功能、主动活动范围和疼痛评分明显较低。单因素分析确定类风湿关节炎（P=0.029；OR，2.74）和糖尿病（P=0.028；OR，1.84）是 rTSA 后无菌性肩胛盂松动的显著危险因素，多因素分析确定 Walch 肩胛盂类型 B2（P=0.002；OR，4.513）和 B3（P=0.002；OR，14.804）、使用扩展外侧化肱骨头（P=0.025；OR，2.57）和使用增强型基底部（P=0.001；OR，2.50）为显著危险因素。
评估的内侧化肩胛盂-外侧化肱骨头 rTSA 系统的无菌性肩胛盂基底部松动发生率为 0.74%。确定了许多无菌性松动的危险因素，包括类风湿关节炎、糖尿病、Walch 类型 B2 和 B3 肩胛盂、后上增强基底部和扩展外侧化肱骨头。最后，对多个危险因素组合的分析确定了具有最大无菌性肩胛盂松动风险的患者和植入物配置。
