Hinse Stephanie, Pastor Torsten, Hasler Anita, Ernstbrunner Lukas, Wieser Karl, Gerber Christian
Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.
JSES Int. 2023 Feb 11;7(3):464-471. doi: 10.1016/j.jseint.2023.01.006. eCollection 2023 May.
Eccentric biconcave (B2) glenoid erosion in primary glenohumeral arthritis is common. There are serious concerns regarding the longevity of fixation of cemented glenoids if anatomic total shoulder arthroplasties (aTSAs) are used in B2 glenoid. The purpose of this study is to analyze the mid- to long-term results of aTSA with B2 glenoids.
This is a retrospective study of a single center experience. Thirty patients (32 shoulders) at an average of 9.2 years (range, 5.0-16.6, ±3.2) after primary TSA were evaluated. Clinical and radiographic outcomes were analyzed.
The mean preoperative intermediate glenoid version was -14° ± 7° (range, -2° to -29°) and the mean humeral subluxation according to the plane of the scapula was 67% ± 9% (range, 49%-87%). There was a significant improvement for all the postoperative clinical outcome parameters including the mean absolute and relative Constant Score, subjective shoulder value, active elevation, external rotation, abduction, internal rotation, pain scores, and strength ( < .001). The complication rate was 15.6% and the revision rate was 12.5% at a mean follow-up of 9.2 years (range, 5.0-16.6, ±3.2). The estimated survivorship without revision was 94% at 5 years and 85% at 10 years (12.1-14.7 years). The survival rate without advanced glenoid component loosening (defined as Lazarus grade ≥ 4 or modified Molé scores ≥ 6) was 91% at 5 years and 84% at 10 years (12.2-15.8 years).
In this case series, aTSA with asymmetric reaming for the treatment of shoulder osteoarthritis with milder forms of B2 glenoid is a viable option with good to excellent clinical results and an 85% prosthetic survivorship at 10 years.
原发性盂肱关节炎中偏心双凹（B2）型关节盂侵蚀很常见。如果在B2型关节盂中使用解剖型全肩关节置换术（aTSA），对于骨水泥固定关节盂的固定持久性存在严重担忧。本研究的目的是分析aTSA治疗B2型关节盂的中长期结果。
这是一项对单一中心经验的回顾性研究。对30例患者（32个肩关节）进行评估，这些患者在初次TSA术后平均9.2年（范围5.0 - 16.6年，±3.2年）。分析临床和影像学结果。
术前平均关节盂中间位版本为-14°±7°（范围-2°至-29°），根据肩胛骨平面的平均肱骨半脱位为67%±9%（范围49% - 87%）。所有术后临床结果参数均有显著改善，包括平均绝对和相对Constant评分、主观肩关节评分、主动抬高、外旋、外展、内旋、疼痛评分和力量（P <.001）。平均随访9.2年（范围5.0 - 16.6年，±3.2年）时，并发症发生率为15.6%，翻修率为12.5%。5年时无翻修的估计生存率为94%，10年时为85%(12.1 - 14.7年)。无严重关节盂组件松动（定义为拉撒路分级≥4或改良莫勒评分≥6）的生存率5年时为91%，10年时为84%(12.2 - 15.8年)。
在本病例系列中，采用不对称扩孔的aTSA治疗轻度B2型关节盂的肩关节骨关节炎是一种可行的选择，临床效果良好至优秀，10年时假体生存率为85%。
