Su Favian, Nuthalapati Prashant, Feeley Brian T, Lansdown Drew A
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
University of Texas at Dallas, Richardson, TX, USA.
JSES Rev Rep Tech. 2023 Mar 4;3(2):181-188. doi: 10.1016/j.xrrt.2023.02.003. eCollection 2023 May.
Both anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably improve pain and function for a variety of indications. However, there remain concerns about these procedures among elderly patients due to their general health, the potential for lesser functional gain, and the possible need for revision at an even older age. The purpose of this review is to compare the clinical outcomes, radiographic outcomes, and complications of ATSA and RTSA among patients older than 70 years.
A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. The inclusion criteria were studies with patients older than 70 years who were treated with a primary ATSA or RTSA and clinical results reported at a minimum of 2 years. All indications for primary RTSA except for tumor were included. Outcomes of interest included patient-reported outcomes (PROs), range of motion, patient satisfaction, radiographic changes, complication and revision rates, and implant survival.
A total of 24 studies met the inclusion criteria. At a mean follow-up of 3.4 years for ATSA and 3.1 years for RTSA, there were significant improvements in pain, range of motion, and PROs for both prostheses. Patients who underwent ATSA generally had better motion and functional outcomes compared to those who underwent RTSA, though these comparisons were made across different indications for arthroplasty. The satisfaction rate was 90.9% after ATSA and 90.8% after RTSA. Furthermore, 10.2% of ATSA patients and 9.9% of RTSA patients experienced a surgical complication, whereas 2.3% of ATSA and 2.2% of RTSA patients underwent a revision. Secondary rotator cuff tear was the most common complication after ATSA, occurring in 3.7% of patients, but only 1.1% of patients required revision surgery. Both ATSA and RTSA implant survivorship was reported to range from 93.1% to 98.9% at 5- and 8-year follow-up, respectively. Patient mortality was estimated to be 19.3% with a mean time to death of 6.1 years.
Elderly patients with primary osteoarthritis and an intact rotator cuff can have predictable pain relief, restoration of functional range of motion, and significant improvement in PROs after ATSA with low complication rates. Secondary rotator cuff failure and revision arthroplasty occur infrequently at early to mid-term follow-up. Although elderly patients who underwent ATSA generally had better functional outcomes compared to those who underwent RTSA for differing indications, patient satisfaction after both procedures were similar.
解剖型全肩关节置换术（ATSA）和反置全肩关节置换术（RTSA）均可有效改善多种适应证患者的疼痛和功能。然而，老年患者对这些手术仍存在担忧，原因包括他们的总体健康状况、功能改善可能较小以及可能在更高龄时需要翻修手术。本综述的目的是比较70岁以上患者中ATSA和RTSA的临床结果、影像学结果及并发症。
通过检索PubMed、Embase和Cochrane数据库进行系统综述。纳入标准为对70岁以上接受初次ATSA或RTSA治疗且至少随访2年并报告临床结果的研究。除肿瘤外，纳入初次RTSA的所有适应证。感兴趣的结果包括患者报告的结果（PROs）、活动范围、患者满意度、影像学改变、并发症和翻修率以及植入物生存率。
共有24项研究符合纳入标准。ATSA的平均随访时间为3.4年，RTSA为3.1年，两种假体在疼痛、活动范围和PROs方面均有显著改善。与接受RTSA的患者相比，接受ATSA的患者通常具有更好的活动度和功能结果，不过这些比较是针对不同的关节置换适应证进行的。ATSA后的满意率为90.9%，RTSA后为90.8%。此外，10.2%的ATSA患者和9.9%的RTSA患者发生手术并发症，而2.3%的ATSA患者和2.2%的RTSA患者接受了翻修手术。继发性肩袖撕裂是ATSA后最常见的并发症，发生率为3.7%，但仅1.1%的患者需要翻修手术。据报道，ATSA和RTSA植入物在5年和8年随访时的生存率分别为93.1%至98.9%。患者死亡率估计为19.3%，平均死亡时间为6.1年。
患有原发性骨关节炎且肩袖完整的老年患者在接受ATSA后可获得可预测的疼痛缓解、功能活动范围恢复以及PROs的显著改善，并发症发生率低。继发性肩袖功能障碍和翻修关节成形术在早期至中期随访中很少发生。尽管因适应证不同，接受ATSA的老年患者通常比接受RTSA的患者功能结果更好，但两种手术术后的患者满意度相似。
