Conyer Ryan T, Markos James R, Marigi Erick M, Cates Robert A, Steinmann Scott P, Sperling John W
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, University of Tennessee, Chattanooga, TN, USA.
JSES Rev Rep Tech. 2023 Apr 7;3(3):289-294. doi: 10.1016/j.xrrt.2023.03.003. eCollection 2023 Aug.
Walch B2 glenoids present unique challenges to the shoulder arthroplasty surgeon, particularly in young, active patients who may wish to avoid the restrictions typically associated with an anatomic total shoulder arthroplasty (TSA). Long-term data are limited when comparing hemiarthroplasty (HA) and TSA for patients with an intact rotator cuff. The purpose of our study was to compare the long-term outcomes of HA vs. TSA in a matched analysis of patients with B2 glenoids, primary osteoarthritis (OA), and an intact rotator cuff.
A retrospective review was performed of all patients who underwent HA or TSA between January 2000 and December 2011 at a single institution. Inclusion criteria were primary OA, Walch B2 glenoid morphology, an intact rotator cuff intraoperatively, at least 2 years of clinical follow-up, or revision within 2 years of surgery. Fifteen HAs met inclusion criteria and were matched 1:2 with 30 TSAs using age, sex, body mass index, and implant selection. Clinical outcomes including range of motion (ROM), visual analog scale (VAS) for pain, subjective shoulder value score, American Shoulder and Elbow Surgeons (ASES) score, complications, and revisions were recorded. Postoperative radiographs were reviewed to assess for stem loosening, humeral head subluxation, glenoid loosening, and glenoid erosion.
A total of 15 HAs and 30 TSAs met inclusion criteria at a mean follow-up of 9.3 years. The mean age at the time of surgery was 60.2 years for HA and 65.4 years for TSA ( = .08). Both cohorts had significant improvements in ROM, subjective shoulder value, and VAS pain scores ( < .001). TSA had higher postoperative ASES scores compared to HA ( = .03) and lower postoperative VAS pain scores ( = .03), although the decrease in pain from preoperatively to final follow-up was not significantly different between HA and TSA ( = .11). HAs were more likely to have posterior humeral subluxation ( < .001) and stem lucencies ( = .02). Revisions occurred in 11.1% of the cohort with no difference for HA and TSA ( = .73).
At nearly 10 years of follow-up, HA and TSA both showed significant improvements in ROM and pain when performed for primary glenohumeral OA in B2 glenoids with intact rotator cuffs. Compared to HA, TSAs had less posterior humeral subluxation, less stem lucencies, higher ASES scores, and lower postoperative VAS pain scores. However, our study failed to demonstrate a difference in ROM, complication, or revision rates between HA and TSA.
Walch B2型肩胛盂给肩关节置换手术医生带来了独特的挑战，尤其是对于那些可能希望避免解剖型全肩关节置换术（TSA）通常所带来限制的年轻、活跃患者。在比较半肩关节置换术（HA）和TSA治疗肩袖完整患者时，长期数据有限。我们研究的目的是在一项对B2型肩胛盂、原发性骨关节炎（OA）且肩袖完整的患者进行匹配分析中，比较HA与TSA的长期疗效。
对2000年1月至2011年12月在单一机构接受HA或TSA的所有患者进行回顾性研究。纳入标准为原发性OA、Walch B2型肩胛盂形态、术中肩袖完整、至少2年的临床随访或术后2年内翻修。15例HA符合纳入标准，并根据年龄、性别、体重指数和植入物选择以1:2与30例TSA进行匹配。记录临床结果，包括活动范围（ROM）、疼痛视觉模拟量表（VAS）、主观肩关节价值评分、美国肩肘外科医生（ASES）评分、并发症和翻修情况。回顾术后X线片以评估柄松动、肱骨头半脱位、肩胛盂松动和肩胛盂侵蚀情况。
共有15例HA和30例TSA符合纳入标准，平均随访9.3年。HA手术时的平均年龄为60.2岁，TSA为65.4岁（P = 0.08）。两组在ROM、主观肩关节价值和VAS疼痛评分方面均有显著改善（P < 0.001）。与HA相比，TSA术后ASES评分更高（P = 0.03），术后VAS疼痛评分更低（P = 0.03），尽管HA和TSA从术前到最终随访时疼痛的减轻无显著差异（P = 0.11）。HA更易出现肱骨头后脱位（P < 0.001）和柄透亮区（P = 0.02）。该队列中11.1%发生翻修，HA和TSA之间无差异（P = 0.73）。
在近10年的随访中，对于B2型肩胛盂且肩袖完整的原发性盂肱关节OA患者，HA和TSA在ROM和疼痛方面均有显著改善。与HA相比，TSA的肱骨头后脱位更少、柄透亮区更少、ASES评分更高且术后VAS疼痛评分更低。然而，我们的研究未能证明HA和TSA在ROM、并发症或翻修率方面存在差异。
