Olson Jeffrey J, Granger Caroline J, Hill J Ryan, Aleem Alexander W, Keener Jay D, Zmistowski Benjamin M
Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
J Shoulder Elbow Surg. 2024 Apr;33(4):908-915. doi: 10.1016/j.jse.2023.07.030. Epub 2023 Aug 28.
The prevalence of failed reverse total shoulder arthroplasty (rTSA) is increasing. This can often present a challenging clinical situation with substantial bone loss and limited reconstruction options. This study reports a single tertiary referral center's experience with revision of failed rTSA managed with revision rTSA of bone-interfacing components.
After institutional review board approval, all revision shoulder arthroplasty cases performed at a single institution between 2012 and 2020 were reviewed. Cases in which rTSA was revised to a new rTSA construct with revision of at least 1 bone-interfacing implant (humeral stem and/or baseplate) with a minimum 2-year follow-up were identified. Characteristics of revision cases-including indications, bony stock, revised components, and use of bone graft-were collected. All patients were contacted for patient-reported outcome measures at a minimum of 2 years after surgery. In addition, the incidence and indication for any reoperation after revision were determined.
Thirty-three patients with an average age of 66 years (range: 46-82 years), with 19 (58%) being female, met the inclusion criteria and had a mean follow-up of 4.2 years (range: 2-8 years). The most common indication for revision rTSA included humeral component loosening (33%; 11/33), baseplate loosening (27%; 9/33), and instability (21%; 7/33). Prerevision infectious workup demonstrated no cases of periprosthetic shoulder infection. Thirteen cases had massive bone loss-5 treated with humeral allograft prosthetic composite, 5 with glenoid bone grafting, and 3 with custom glenoid implant. In total, 10 of 33 cases (30%) required reoperation at a mean of 13 months (range: 1-44 months) for instability (4), humeral loosening (2), infection (1), baseplate loosening (1), or periprosthetic fracture (1). The reoperation rate for patients with revised baseplates only, humerus only, or combined was 23% (3/13), 28% (5/18), and 27% (3/11), respectively. Overall, the visual analog scale pain score improved from 6.5 preoperatively to 2.0 (P < .001), and the American Shoulder and Elbow Surgeons score improved from 30.7 to 67.5 (P < .001). However, the postoperative Single Assessment Numeric Evaluation score averaged only 51.2% (range: 2-100%).
This study demonstrates that failed rTSA can be salvaged with a revision rTSA. However, patient expectations for functional improvements should be tempered, and a high reoperation rate should be expected.
翻修性全肩关节置换术（rTSA）失败的发生率正在上升。这常常带来具有挑战性的临床情况，伴有大量骨质流失且重建选择有限。本研究报告了一家三级转诊中心对采用骨界面组件翻修性rTSA治疗失败的rTSA的经验。
经机构审查委员会批准，对2012年至2020年在单一机构进行的所有翻修性肩关节置换术病例进行回顾。确定rTSA被翻修为新的rTSA结构且至少1个骨界面植入物（肱骨干和/或基板）进行翻修且随访至少2年的病例。收集翻修病例的特征，包括适应证、骨量、翻修组件和骨移植的使用情况。在术后至少2年时联系所有患者以获取患者报告的结局指标。此外，确定翻修后再次手术的发生率和适应证。
33例患者，平均年龄66岁（范围：46 - 82岁），其中19例（58%）为女性，符合纳入标准，平均随访4.2年（范围：2 - 8年）。翻修性rTSA最常见的适应证包括肱骨头组件松动（33%；11/33）、基板松动（27%；9/33）和不稳定（21%；7/33）。翻修前的感染检查未发现假体周围肩部感染病例。13例有大量骨质流失，5例采用肱骨头同种异体假体复合物治疗，5例采用肩胛盂植骨，3例采用定制肩胛盂植入物。33例患者中共有10例（30%）在平均13个月（范围：1 - 44个月）时因不稳定（4例）、肱骨头松动（2例）、感染（1例）、基板松动（1例）或假体周围骨折（1例）需要再次手术。仅翻修基板、仅翻修肱骨头或两者联合翻修的患者再次手术率分别为23%（3/13）、28%（5/18）和27%（3/11）。总体而言，视觉模拟评分法疼痛评分从术前的6.5分改善至2.0分（P <.001），美国肩肘外科医师评分从30.7分提高至67.5分（P <.001）。然而，术后单项评估数字评价评分平均仅为51.2%（范围：2 - 100%）。
本研究表明，失败的rTSA可通过翻修性rTSA挽救。然而，应降低患者对功能改善的期望，并预期有较高的再次手术率。
