From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center-RWJBarnabas Health, Livingston, NJ/Jersey City, NJ.
J Am Acad Orthop Surg Glob Res Rev. 2023 Oct 12;7(10). doi: 10.5435/JAAOSGlobal-D-23-00160. eCollection 2023 Oct 1.
Indications for reverse total shoulder arthroplasty (rTSA) has expanded to encompass complex proximal humerus fractures (PHFs) in recent years. The purpose of this study was to report and assess whether PHF patients treated with rTSA could achieve similar functional outcomes and short-term survivorship to patients who underwent rTSA for rotator cuff arthropathy (RTCA).
All consecutive patients with a preoperative diagnosis of PHF or RTCA, 18 years or older, treated with rTSA at a single academic institution between 2018 and 2020 with a minimum 2-year follow-up were retrospectively reviewed. Primary outcomes were survivorship defined as revision surgery or implant failure analyzed using the Kaplan-Meier survival curve, and functional outcomes, which included Quick Disabilities of the Arm, Shoulder, and Hand, and range of motion (ROM) were compared at multiple follow-up time points up to 2 years. Secondary outcomes were patient demographics, comorbidities, surgical data, length of hospital stay, and discharge disposition.
A total of 48 patients were included: 21 patients (44%) were diagnosed with PHF and 27 patients (56%) had RTCA. The Kaplan-Meier survival rate estimates at 3 years were 90.5% in the PHF group and 85.2% in the RTCA group. No differences in revision surgery rates between the two groups (P = 0.68) or survivorship (P = 0.63) were found. ROM was significantly lower at subsequent follow-up time points in multiple planes (P < 0.05). A greater proportion of patients in the PHF group received cement for humeral implant fixation compared with the RTCA group (48% versus 7%, P = 0.002). The mean length of hospital stay was longer in PHF patients compared with RTCA patients (2.9 ± 3.8 days versus 1.6 ± 1.8 days, P = 0.13), and a significantly lower proportion of PHF patients were discharged home (67% versus 96%, P = 0.015).
The rTSA implant survivorship at 3 years for both PHF and RTCA patients show comparable results. At the 2-year follow-up, RTCA patients treated with rTSA were found to have better ROM compared with PHF patients.
近年来，反向全肩关节置换术（rTSA）的适应证已扩展至复杂肱骨近端骨折（PHF）。本研究旨在报告和评估接受 rTSA 治疗的 PHF 患者是否能获得与接受 rTSA 治疗肩袖关节炎（RTCA）患者相似的功能结果和短期生存率。
回顾性分析 2018 年至 2020 年在一家学术机构接受 rTSA 治疗的术前诊断为 PHF 或 RTCA、年龄 18 岁或以上的连续患者，随访时间至少 2 年。主要结局为使用 Kaplan-Meier 生存曲线分析的定义为翻修手术或植入物失败的生存率，以及在 2 年多的多个随访时间点比较的功能结果，包括 Quick Disabilities of the Arm、Shoulder, and Hand 和活动范围（ROM）。次要结局包括患者人口统计学、合并症、手术数据、住院时间和出院情况。
共纳入 48 例患者：21 例（44%）诊断为 PHF，27 例（56%）为 RTCA。PHF 组和 RTCA 组的 3 年 Kaplan-Meier 生存率估计分别为 90.5%和 85.2%。两组之间的翻修手术率（P = 0.68）或生存率（P = 0.63）无差异。在多个平面的后续随访时间点，ROM 明显较低（P < 0.05）。与 RTCA 组相比，PHF 组更多的患者接受了肱骨植入物固定的水泥（48%比 7%，P = 0.002）。与 RTCA 患者相比，PHF 患者的平均住院时间更长（2.9 ± 3.8 天比 1.6 ± 1.8 天，P = 0.13），且显著更低比例的 PHF 患者出院回家（67%比 96%，P = 0.015）。
PHF 和 RTCA 患者的 rTSA 植入物 3 年生存率结果相当。在 2 年随访时，接受 rTSA 治疗的 RTCA 患者的 ROM 明显优于 PHF 患者。
