Nové-Josserand Laurent, Nerot Cecile, Colotte Philippe, Guery Jacques, Godenèche Arnaud
Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France; SoFEC - French Shoulder and Elbow Society, Paris, France.
SoFEC - French Shoulder and Elbow Society, Paris, France; Reims University Hospital, Reims, France.
J Shoulder Elbow Surg. 2024 Apr;33(4):850-862. doi: 10.1016/j.jse.2023.07.027. Epub 2023 Aug 25.
To compare outcomes of reverse shoulder arthroplasty (RSA) for primary osteoarthritis (OA) with and without rotator cuff (RC) tears to those with secondary OA due to RC tears.
We reviewed records of all patients who received RSA for primary OA or secondary OA. All patients had preoperative radiographs, computed tomographic arthrography (CTA), and/or magnetic resonance imaging (MRI) scans of their shoulders to assess their etiology, glenoid morphology, and fatty infiltration. Pre- and postoperative (at minimum follow-up of 2 years) Constant scores and range of motion were compared between patients who had RSA for primary OA with and without RC tears to those with secondary OA due to RC tears.
Of the initial cohort of 605 shoulders (583 patients), 153 were lost to follow-up (25.3%), 25 required revision with implant removal (4.1%), and 13 died of causes unrelated to the surgery (2.1%), and left a final cohort of 414 patients. Of the final cohort, 97 had primary OA with intact RC, 62 had primary OA with RC tears, and 255 had secondary OA. Postoperative Constant scores were significantly higher for primary OA with intact RC (73.8 ± 14.3), compared with both primary OA with RC tears (66.1 ± 14.6, P < .001) and secondary OA (64.1 ± 14.8, P < .001). There were no differences in pre- or postoperative scores between primary OA with RC tears and secondary OA.
At 2 or more years following RSA, Constant scores were significantly higher for primary OA with intact RC, compared to either primary OA with RC tears or secondary OA, whereas there were no differences in pre- or postoperative scores of shoulders that had primary OA with RC tears vs. secondary OA. The authors recommend distinguishing primary OA with intact RC from primary OA with RC tears, as the two have considerably different characteristics and prognosis following RSA.
比较原发性骨关节炎（OA）伴或不伴肩袖（RC）撕裂行反式肩关节置换术（RSA）的疗效与因RC撕裂导致的继发性OA行RSA的疗效。
我们回顾了所有接受RSA治疗原发性OA或继发性OA患者的记录。所有患者术前行肩部X线片、计算机断层扫描关节造影（CTA）和/或磁共振成像（MRI）扫描，以评估其病因、关节盂形态和脂肪浸润情况。比较原发性OA伴或不伴RC撕裂行RSA的患者与因RC撕裂导致的继发性OA行RSA的患者术前和术后（至少随访2年）的Constant评分及活动范围。
在最初的605例肩部病例（583例患者）中，153例失访（25.3%），25例需要翻修并取出植入物（4.1%），13例死于与手术无关的原因（2.1%），最终队列中有414例患者。在最终队列中，97例为原发性OA且RC完整，62例为原发性OA伴RC撕裂，255例为继发性OA。原发性OA且RC完整患者术后Constant评分（73.8±14.3）显著高于原发性OA伴RC撕裂患者（66.1±14.6，P<.001）和继发性OA患者（64.1±14.8，P<.001）。原发性OA伴RC撕裂患者与继发性OA患者术前或术后评分无差异。
RSA术后2年或更长时间，原发性OA且RC完整患者的Constant评分显著高于原发性OA伴RC撕裂患者或继发性OA患者，而原发性OA伴RC撕裂患者与继发性OA患者术前或术后评分无差异。作者建议区分原发性OA且RC完整与原发性OA伴RC撕裂，因为二者在RSA术后具有相当不同的特征和预后。
