Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan; Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan.
J Shoulder Elbow Surg. 2023 Jul;32(7):1445-1451. doi: 10.1016/j.jse.2022.12.025. Epub 2023 Feb 2.
No consensus has been reached on the return to sports or physical work after shoulder arthroplasty due to a shortage of literature. The purpose of this study was to investigate return to sports or physical work after anatomical total shoulder arthroplasty (aTSA) and reverse shoulder arthroplasty (RSA), as well as the clinical and radiographic outcomes.
The inclusion criteria were as follows: 1) aTSA or RSA between 2012 and 2017, and 2) patients who preoperatively participated in sports or physical work. The exclusion criteria were as follows: 1) revision arthroplasty, 2) fracture/dislocation, 3) fracture sequelae, 4) postinfection, and 5) <2-year follow-up. Sports and physical work were classified as low-, medium-, or high-load activities. Range of motion, Constant score, sport or work return, and radiographic findings were evaluated and compared between aTSA and RSA groups.
The subjects who met the criteria were 90 shoulders in 86 patients. The aTSA group consisted of 30 shoulders (10 men and 20 women) with a mean age of 71 ± 8 years (range, 56-85). The RSA group consisted of 60 shoulders (39 men and 21 women) with a mean age of 72 ± 6 years (range, 56-83). Active range of motion significantly improved after surgery in all directions in the aTSA group but only in flexion and external rotation in the RSA group. Postoperative external and internal rotations, as well as postoperative Constant scores and satisfaction, were significantly better in the aTSA than in the RSA group. In the aTSA group, the return rate was 93%, and the complete return rate was 70%. In the RSA group, the return rate was 83%, and the complete return rate was 30%. The complete return rate was significantly higher in the aTSA than in the RSA group. Only one aTSA shoulder showed loosening of the glenoid implant, and 8 RSA shoulders demonstrated low-grade scapular notching.
The return to sports or physical work rates after aTSA and RSA were high; however, the complete return rates were significantly higher in the aTSA group than in the RSA group. No radiographic failures were identified except for one asymptomatic glenoid loosening with a midterm follow-up.
由于文献不足，对于肩关节炎术后患者何时能够重返运动或体力劳动，目前尚无定论。本研究旨在探讨解剖型全肩关节置换术（aTSA）和反式肩关节置换术（RSA）后患者重返运动或体力劳动的情况，以及临床和影像学结果。
纳入标准为：1）2012 年至 2017 年期间行 aTSA 或 RSA，2）术前参与运动或体力劳动。排除标准为：1）翻修手术，2）骨折/脱位，3）骨折后遗症，4）感染后，5）随访时间<2 年。运动和体力劳动分为低、中、高负荷活动。评估和比较 aTSA 组和 RSA 组患者的关节活动度、Constant 评分、重返运动或体力劳动情况以及影像学发现。
符合标准的患者共 90 例（86 例患者），100 个肩关节。aTSA 组 30 个肩关节（10 例男性，20 例女性），平均年龄 71±8 岁（56-85 岁）。RSA 组 60 个肩关节（39 例男性，21 例女性），平均年龄 72±6 岁（56-83 岁）。aTSA 组所有方向的主动关节活动度在术后均显著改善，但 RSA 组仅在屈曲和外旋方向改善。术后外旋和内旋、术后 Constant 评分和满意度在 aTSA 组均显著优于 RSA 组。aTSA 组的重返率为 93%，完全重返率为 70%。RSA 组的重返率为 83%，完全重返率为 30%。aTSA 组的完全重返率显著高于 RSA 组。仅 1 例 aTSA 肩关节出现肩胛盂假体松动，8 例 RSA 肩关节出现轻度肩胛盂切迹。
aTSA 和 RSA 后患者重返运动或体力劳动的比例较高；然而，aTSA 组的完全重返率明显高于 RSA 组。除中期随访时出现 1 例无症状肩胛盂松动外，未见影像学失败。
