Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA; OrthoCincy, Edgewood, KY, USA.
Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA.
J Shoulder Elbow Surg. 2024 Feb;33(2):425-434. doi: 10.1016/j.jse.2023.08.003. Epub 2023 Sep 9.
Elderly patients and their surgeons may eschew shoulder arthroplasty due to concerns over patient safety and longevity. The purpose of this study was to review the current literature evaluating the clinical and radiographic outcomes of shoulder arthroplasty performed in patients 80 years and older.
A literature search of the Embase, PubMed, Medline, and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating the outcomes of primary and revision anatomic (aTSA) and reverse (RSA) total shoulder arthroplasty in patients 80 years and older were included for analysis.
A total of 15 studies evaluating 1685 primary aTSAs, 1170 primary RSAs, 69 RSAs performed for fracture, and 45 revision RSAs were included for review. The postoperative active forward flexion and external rotation ranged from 138° to 150° and 45° to 48° after aTSA and from 83° to 139° and 16° to 47° after RSA, respectively. Postoperative visual analog scale pain scores ranged from 0 to 1.8 after aTSA and from 0 to 1.4 after RSA. Ninety-day mortality ranged from 0% to 3%, and perioperative complications ranged from 0% to 32%. Late complications ranged from 5.6% to 24% for aTSA patients and 3.5% to 29% for patients undergoing RSA for all indications. Common complications included glenoid loosening (0%-18%) and rotator cuff tear (5.6%-10%) after aTSA and scapular notching (0%-40%) and scapular fracture (4%-9.4%) after RSA. Reoperation rates ranged from 0% to 6% after aTSA and from 0% to 13% after RSA.
aTSA and RSA in this population are safe and effective, demonstrating low rates of perioperative mortality and reoperation, durability that exceeds patient longevity, satisfactory postoperative range of motion, and excellent pain relief. Late complication rates appear to be similar for aTSA and RSA.
由于对患者安全和寿命的担忧，老年患者及其外科医生可能会回避肩关节置换术。本研究的目的是回顾评估在 80 岁及以上患者中进行肩关节置换术的临床和影像学结果的现有文献。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 Embase、PubMed、Medline 和 Cochrane 数据库进行文献检索。纳入分析评估原发性和翻修解剖型（aTSA）和反式（RSA）全肩关节置换术在 80 岁及以上患者中的结果的研究。
共纳入 15 项研究，评估了 1685 例初次 aTSA、1170 例初次 RSA、69 例 RSA 治疗骨折和 45 例 RSA 翻修。术后主动前屈和外旋范围分别为 aTSA 后 138°至 150°和 45°至 48°，RSA 后 83°至 139°和 16°至 47°。术后视觉模拟评分疼痛范围 aTSA 后为 0 至 1.8，RSA 后为 0 至 1.4。90 天死亡率范围为 0%至 3%，围手术期并发症范围为 0%至 32%。晚期并发症在 aTSA 患者中为 5.6%至 24%，在所有适应症接受 RSA 的患者中为 3.5%至 29%。常见并发症包括 aTSA 后肩盂松动（0%-18%）和肩袖撕裂（5.6%-10%）以及 RSA 后肩胛切迹（0%-40%）和肩胛骨折（4%-9.4%）。翻修率 aTSA 后为 0%至 6%，RSA 后为 0%至 13%。
在该人群中，aTSA 和 RSA 是安全有效的，围手术期死亡率和翻修率低，耐用性超过患者寿命，术后活动范围满意，疼痛缓解效果极佳。aTSA 和 RSA 的晚期并发症发生率似乎相似。
