Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, 3-5 Konstantopoulou Str, 14233, Athens, Greece.
Eur J Orthop Surg Traumatol. 2023 Dec;33(8):3531-3538. doi: 10.1007/s00590-023-03584-0. Epub 2023 May 22.
The outcomes of shoulder hemiarthroplasty are highly dependent on the baseline glenoid morphology and the rotator cuff integrity. The objective of this study was to assess whether certain glenoid parameters and implant overstuffing are associated with worse clinical outcomes following shoulder hemiarthroplasty.
We retrospectively reviewed 25 patients who underwent shoulder hemiarthroplasty for shoulder arthritis, with a mean follow-up of 5.3 years. The baseline glenoid morphology, the glenoid wear rate, the proximal humeral head migration and implant overstuffing were evaluated radiologically in all patients. The radiological parameters were correlated with the functional outcomes.
The Constant-Murley score, the ASES score, and the OSS score were significantly better for patients with a concentric baseline glenoid compared to those with an eccentric glenoid. The Constant-Murley score and the ASES score were also improved in patients without implant overstuffing compared to patients with implant overstuffing (p < 0.05). However, glenoid wear was not associated with worse functional outcomes (p = 0.23 for Constant-Murley score, p = 0.15 for ASES score and p = 0.27 for OSS score). Last, a worse Constant-Murley score was strongly correlated with proximal humeral head migration (p < 0.001), while worse ASES and OSS scores were moderately correlated with proximal humeral head migration (p < 0.001).
Our findings indicate that the results of hemiarthroplasty can be improved through careful selection of patients upon the baseline glenoid type morphology and proper implant sizing to avoid implant overstuffing. Moreover, glenoid wear is not associated with worse clinical outcomes, therefore shoulder hemiarthroplasty should be reconsidered as an alternative in younger patients with shoulder arthritis.
肩关节半关节置换术的结果高度依赖于肩胛盂的基线形态和肩袖的完整性。本研究的目的是评估特定的肩胛盂参数和假体过度填充是否与肩关节半关节置换术后的临床结果较差有关。
我们回顾性分析了 25 例因肩关节关节炎接受肩关节半关节置换术的患者，平均随访 5.3 年。所有患者均行影像学检查评估基线肩胛盂形态、肩胛盂磨损率、肱骨头近端迁移和假体过度填充。影像学参数与功能结果相关。
与偏心肩胛盂患者相比，基线为同心圆的患者的 Constant-Murley 评分、ASES 评分和 OSS 评分显著更高。与假体过度填充的患者相比，无假体过度填充的患者的 Constant-Murley 评分和 ASES 评分也有所改善（p<0.05）。然而，肩胛盂磨损与较差的功能结果无关（Constant-Murley 评分 p=0.23，ASES 评分 p=0.15，OSS 评分 p=0.27）。最后，较差的 Constant-Murley 评分与肱骨头近端迁移呈强相关（p<0.001），而较差的 ASES 和 OSS 评分与肱骨头近端迁移呈中度相关（p<0.001）。
我们的研究结果表明，通过仔细选择肩胛盂基线形态类型和适当的假体大小，可以改善半关节置换术的结果，避免假体过度填充。此外，肩胛盂磨损与较差的临床结果无关，因此对于年轻的肩关节关节炎患者，应重新考虑肩关节半关节置换术作为替代治疗方法。
