O'Driscoll Conor S, Davey Martin S, Molony Diarmuid C, Shannon Fintan J, Mullett Hannan
Beaumont Hospital, Dublin, Ireland.
Royal College of Surgeons of Ireland, Dublin, Ireland.
JSES Rev Rep Tech. 2023 Feb 4;3(2):166-180. doi: 10.1016/j.xrrt.2023.01.003. eCollection 2023 May.
Anterior shoulder instability causes considerable patient morbidity and the volume of shoulder stabilization surgery being performed annually is rising. Despite stabilization surgery, instability arthropathy in the long-term may arise requiring consideration of shoulder arthroplasty. This study evaluated the outcomes of shoulder arthroplasty following previous stabilization surgery with their associated changes in bony anatomy or soft tissue structure.
A systematic review was performed as per Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify all studies reporting outcomes of shoulder arthroplasty in the setting of previous stabilization surgery. Studies of >10 patients with a minimum of 24 months follow-up were included.
Overall, 377 shoulder arthroplasties composed of 247 anatomical total shoulder arthroplasties (aTSAs), 102 reverse total shoulder arthroplasties (RTSAs), and 28 hemiarthroplasties (HAs) were reported across 14 included studies at mean age 55.4 years, with 203 compared to 451 control shoulders in 7 matched case-control studies. The mean interval from arthroplasty to stabilization procedure was 19.7 years, with 27.2% of patients having undergone multiple procedures and 39.5% bone transfer procedures. Improvements in patient outcomes were observed both for patients who had underwent aTSA or RTSA, with the American Shoulder and Elbow Surgeons score the most commonly used scoring system. Across matched studies comparing to control, large improvements in American Shoulder and Elbow Surgeons were seen for both aTSA and RTSA implants, 38.1-80.5 and 34.9-82.3, which compared to control groups 38.0-85.5 and 35.5-82.3, respectively. There were differences observed in complication profiles between aTSA and RTSA procedures, with lower revision rates in the short-term to medium-term for RTSA implants in present literature. A significantly higher rate of aTSA revision was observed compared to matched control patients undergoing aTSA for primary osteoarthritis without previous stabilization surgery, 9.4% (13/139) vs. 4.1% (11/269) ( = .044). Aseptic loosening posed a particular challenge in the aTSA group, with significantly higher rates of 5.0% (7/139 f = 54.6 months) compared to control 0.74% (2/269 f = 49.1 months, = .0088). No significant difference in infection rate was observed between matched study and control groups, 1.5% vs. 2.2% ( = .76).
Shoulder arthroplasty may improve functional outcomes for patients experiencing instability arthropathy with a history of stabilization surgery. Careful consideration of potential complications is warranted both in surgical planning and patient counselling given the altered anatomy and biomechanics, with significantly higher revision and loosening rates observed following aTSA compared to control.
肩关节前不稳定会给患者带来相当大的痛苦，并且每年进行的肩关节稳定手术数量在不断增加。尽管进行了稳定手术，但长期来看仍可能出现不稳定关节病，需要考虑进行肩关节置换术。本研究评估了先前进行稳定手术后肩关节置换术的结果及其相关的骨骼解剖结构或软组织结构变化。
按照系统评价和Meta分析的首选报告项目指南进行系统评价，以识别所有报告先前稳定手术后肩关节置换术结果的研究。纳入了10例以上患者且随访至少24个月的研究。
总体而言，14项纳入研究共报告了377例肩关节置换术，其中包括247例解剖型全肩关节置换术（aTSA）、102例反式全肩关节置换术（RTSA）和28例半肩关节置换术（HA），平均年龄55.4岁，在7项匹配的病例对照研究中有203例与451例对照肩进行了比较。从置换术到稳定手术的平均间隔时间为19.7年，27.2%的患者接受了多次手术，39.5%的患者接受了骨转移手术。接受aTSA或RTSA的患者的结局均有改善，美国肩肘外科医生评分是最常用的评分系统。在与对照进行比较的匹配研究中，aTSA和RTSA植入物的美国肩肘外科医生评分均有大幅提高，分别为38.1 - 80.5和34.9 - 82.3，而对照组分别为38.0 - 85.5和35.5 - 82.3。aTSA和RTSA手术的并发症情况存在差异，目前文献中RTSA植入物在短期至中期的翻修率较低。与未进行过先前稳定手术的原发性骨关节炎患者接受aTSA的匹配对照患者相比，观察到aTSA翻修率显著更高，分别为9.4%（13/139）和4.1%（11/269）（P = 0.044）。无菌性松动在aTSA组中是一个特别的挑战，其发生率显著高于对照组，分别为5.0%（7/139，平均随访时间54.6个月）和0.74%（2/269，平均随访时间49.1个月，P = 0.0088）。匹配研究组和对照组之间的感染率无显著差异，分别为1.5%和2.2%（P = 0.76）。
对于有稳定手术史的不稳定关节病患者，肩关节置换术可能改善功能结局。鉴于解剖结构和生物力学的改变，在手术规划和患者咨询中都需要仔细考虑潜在并发症，与对照组相比，aTSA术后观察到显著更高的翻修率和松动率。
