Chamberlain Aaron M, Aleem Alexander W, Sefko Julianne A, Steger-May Karen, Keener Jay D
Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA.
JSES Int. 2023 Jan 13;7(2):277-284. doi: 10.1016/j.jseint.2022.12.018. eCollection 2023 Mar.
Reverse total shoulder arthroplasty (RTSA) has been well-described as a surgical solution to manage rotator cuff tear arthropathy in elderly, low demand paitents. As experience has increased along with improvements in technique and implant design, RTSA has become increasingly used to manage more varied pathologic conditions of the shoulder in younger, more active patients. This study evaluates outcomes in a consecutive series of patients aged 60 years old and younger after undergoing RTSA.
There were 94 shoulders in 89 patients enrolled. Mean age of the cohort was 54.8 (range 18-60 years). Surgical indications included rotator cuff tear arthropathy, irreparable rotator cuff tear without arthritis, glenohumeral arthritis with erosive glenoid deformity, inflammatory arthropathy, proximal humerus fracture nonunion/malunion and failed prior shoulder arthroplasty. Sixty-one shoulders (70%) had undergone at least one prior surgery. Of these, 6 shoulders (6% of total cohort) had a prior failed arthroplasty. Clinical outcomes (American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder index; visual analog scale pain), radiographic outcomes and complications were analyzed and assessed for correlation with patient demographic factors.
The mean follow-up for this cohort was 4.9 years (range 2-12 years). Subjects experienced improvements in ASES score and pain ( < .001) and active forward elevation (88° preop to 135° postop, < .001). Prior operation correlated with worse postoperative ASES and WOOS scores. Higher demand occupation correlated with less improvement in pain scores. The overall complication rate was 12%. Seven shoulders (7%) underwent an additional procedure. There was a 2% incidence of dislocation and a 4% incidence of acromial stress fracture. There was a 36% incidence of notching.
With medium-term follow-up, RTSA is a reliable and predictable operation to manage various pathologic conditions in patients aged 60 years or less. Patients predictably experience significant improvements in pain and range of motion while assuming a modest complication risk. Long-term study is needed to understand potential for late complications or implant failure.
反向全肩关节置换术（RTSA）已被充分描述为一种治疗老年、需求较低患者肩袖撕裂性关节病的手术解决方案。随着经验的增加以及技术和植入物设计的改进，RTSA越来越多地用于治疗年轻、活动量较大患者中更多样化的肩部病理状况。本研究评估了连续一系列60岁及以下患者接受RTSA后的疗效。
纳入89例患者的94个肩部。队列的平均年龄为54.8岁（范围18 - 60岁）。手术适应症包括肩袖撕裂性关节病、无法修复的肩袖撕裂且无关节炎、伴有侵蚀性关节盂畸形的盂肱关节炎、炎性关节病、肱骨近端骨折不愈合/畸形愈合以及既往肩关节置换术失败。61个肩部（70%）至少接受过一次先前手术。其中，6个肩部（占总队列的6%）先前的关节置换术失败。分析并评估临床疗效（美国肩肘外科医师评分、西加拿大肩关节炎指数；视觉模拟量表疼痛评分）、影像学疗效和并发症与患者人口统计学因素的相关性。
该队列的平均随访时间为4.9年（范围2 - 12年）。受试者的美国肩肘外科医师评分和疼痛程度（<0.001）以及主动前屈角度（术前88°，术后135°，<0.001）均有改善。先前手术与术后较差的美国肩肘外科医师评分和西加拿大肩关节炎指数评分相关。需求较高的职业与疼痛评分改善较少相关。总体并发症发生率为12%。7个肩部（7%）接受了额外手术。脱位发生率为2%，肩峰应力性骨折发生率为4%。切迹发生率为36%。
经过中期随访，RTSA是治疗60岁及以下患者各种病理状况的可靠且可预测的手术。患者在承担适度并发症风险的同时，疼痛和活动范围可预期地得到显著改善。需要进行长期研究以了解晚期并发症或植入物失败的可能性。
