Bitzer Alexander, Rondinelli Salvatore, Hurwit Daniel J, Sonnenfeld Julian J, Hong Ian S, Connor Patrick M
OrthoCarolina - Sports Medicine Center, Charlotte, NC, USA.
Atrium Health - Musculoskeletal Institute, Charlotte, NC, USA.
JSES Rev Rep Tech. 2021 Dec 10;2(2):155-163. doi: 10.1016/j.xrrt.2021.11.002. eCollection 2022 May.
Degenerative arthritis of the shoulder is a common condition that is successfully treated with anatomic total shoulder arthroplasty (TSA). Rotator cuff disease has evolved as a leading cause of failure of anatomic TSA, requiring revision to reverse shoulder arthroplasty (RSA). This revision procedure can be extremely complex, particularly if removal of a well-fixed glenoid component is necessary. This case series outlines the technique and preliminary clinical results of conversion of anatomic TSA to RSA utilizing both modular humeral and hybrid glenoid components.
From July 2017 to December 2019, the senior author (PMC) performed 84 consecutive anatomic TSA procedures utilizing a modular humeral arthroplasty system and a unique hybrid glenoid component. Three cases (3/84, or 3.6%) required conversion from anatomic TSA to RSA because of postoperative traumatic rotator cuff failure. All modular revision cases were performed without humeral stem removal and with utilization of the existing, well-fixed hybrid glenoid central titanium peg as the foundation for glenoid component revision. Preoperative and postoperative American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, forward flexion, and patient satisfaction were analyzed in this modular revision group. In addition, several perioperative variables including operative time, blood loss, and length of stay were compared between this modular revision group and a nonmodular anatomic TSA to RSA revision comparative cohort.
At an average follow-up of 24 months, average active forward flexion, postoperative American Shoulder and Elbow Surgeons scores, and visual analog scale pain scores improved significantly compared with preoperative scores in the modular revision group. All three patients were satisfied with their outcome. The average total operative time (109 minutes vs. 154 minutes, = .02), blood loss (183 cc vs. 500 cc, = .08), and length of hospital stay (26.3 hours vs. 36.6 hours < .05) were lower in the modular revision group than those in a nonmodular revision cohort.
Revision of anatomic TSA to RSA utilizing a modular humeral system and a convertible hybrid glenoid component that does not require removal of a well-fixed central titanium peg which serves as the foundation for glenoid component revision was performed efficiently, safely, and successfully in three cases. This technique results in significantly improved clinical outcomes when revision to RSA is needed while potentially decreasing perioperative complications in the revision setting.
肩关节退行性关节炎是一种常见病症，可通过解剖型全肩关节置换术（TSA）成功治疗。肩袖疾病已成为解剖型TSA失败的主要原因，需要翻修为反式肩关节置换术（RSA）。这种翻修手术可能极其复杂，特别是在需要移除固定良好的肩胛盂组件时。本病例系列概述了使用模块化肱骨头组件和混合肩胛盂组件将解剖型TSA转换为RSA的技术及初步临床结果。
2017年7月至2019年12月，资深作者（PMC）连续进行了84例使用模块化肱骨头置换系统和独特混合肩胛盂组件的解剖型TSA手术。3例（3/84，即3.6%）因术后创伤性肩袖失败需要从解剖型TSA转换为RSA。所有模块化翻修病例均未移除肱骨干，并利用现有的、固定良好的混合肩胛盂中央钛钉作为肩胛盂组件翻修的基础。对该模块化翻修组进行术前和术后美国肩肘外科医生评分、视觉模拟量表疼痛评分、前屈和患者满意度分析。此外，比较了该模块化翻修组与非模块化解剖型TSA至RSA翻修对比队列之间的几个围手术期变量，包括手术时间、失血量和住院时间。
在平均24个月的随访中，模块化翻修组的平均主动前屈、术后美国肩肘外科医生评分和视觉模拟量表疼痛评分与术前评分相比有显著改善。所有3例患者对其结果均满意。模块化翻修组的平均总手术时间（109分钟对154分钟，P = 0.02）、失血量（183 cc对500 cc，P = 0.08）和住院时间（26.3小时对36.6小时，P<0.05）均低于非模块化翻修队列。
在3例病例中，使用模块化肱骨头系统和可转换混合肩胛盂组件将解剖型TSA翻修为RSA，该组件无需移除作为肩胛盂组件翻修基础的固定良好的中央钛钉，手术高效、安全且成功。当需要翻修为RSA时，该技术可显著改善临床结果，同时可能减少翻修情况下的围手术期并发症。
