Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA.
J Shoulder Elbow Surg. 2024 Jun;33(6):1235-1242. doi: 10.1016/j.jse.2023.09.033. Epub 2023 Nov 7.
As the utilization and success of reverse total shoulder arthroplasty (RTSA) have continued to grow, so have its surgical indications. Despite the adoption of RTSA for the treatment of glenohumeral osteoarthritis (GHOA) with an intact rotator cuff and irreparable massive rotator cuff tears (MCTs) without arthritis, the literature remains sparse regarding the differential outcomes after RTSA among these varying indications. Thus, the purpose of this study was to examine the postoperative clinical outcomes of RTSA based on indication.
A retrospective review of 2 large institutional databases was performed to identify all patients who underwent RTSA between 2015 and 2019 with minimum 2-year follow-up. Patients were stratified by indication into 3 cohorts: GHOA, rotator cuff tear arthropathy (CTA), and MCT. Baseline demographic characteristics were collected to determine differences between the 3 cohorts. Clinical outcomes were measured preoperatively and postoperatively, including active range of motion, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation score, and visual analog scale pain score. Multivariate linear regression was performed to determine the factors independently predictive of the postoperative ASES score.
A total of 625 patients (383 with GHOA, 164 with CTA, and 78 with MCTs) with a mean follow-up period of 33.4 months were included in the analysis. Patients with GHOA had superior ASES scores (85.6 ± 15.7 vs. 76.6 ± 20.8 in CTA cohort [P < .001] and 75.9 ± 19.9 in MCT cohort [P < .001]), Single Assessment Numeric Evaluation scores (86 ± 20.9 vs. 76.7 ± 24.1 in CTA cohort [P < .001] and 74.2 ± 25.3 in MCT cohort [P < .001]), and visual analog scale pain scores (median [interquartile range], 0.0 [0.0-1.0] vs. 0.0 [0.0-2.0] in CTA cohort [P < .001] and 0.0 [0.0-2.0] in MCT cohort [P < .001]) postoperatively. Postoperative active forward elevation (P < .001) and improvement in active external rotation (P < .001) were greatest in the GHOA cohort compared with other indications. Multivariate linear regression demonstrated that the factors independently associated with the postoperative ASES score included a diagnosis of GHOA (β coefficient, 7.557 [P < .001]), preoperative ASES score (β coefficient, 0.114 [P = .009]), female sex (β coefficient, -4.476 [P = .002]), history of surgery (β coefficient, -3.957 [P = .018]), and postoperative complication (β coefficient, -13.550 [P < .001]).
RTSA for the treatment of GHOA generally has superior patient-reported and functional outcomes when compared with CTA and MCTs without arthritis. Long-term follow-up is needed to identify the lasting implications of such outcome differences.
随着反式全肩关节置换术（RTSA）的应用和成功率不断提高，其手术适应证也在不断扩大。尽管 RTSA 已被用于治疗伴有完整肩袖和不可修复的巨大肩袖撕裂（MCT）但无关节炎的肩肱关节炎（GHOA），但关于这些不同适应证的 RTSA 术后疗效差异的文献仍然很少。因此，本研究旨在根据适应证探讨 RTSA 的术后临床疗效。
对 2 个大型机构数据库进行回顾性分析，以确定 2015 年至 2019 年间接受 RTSA 治疗且随访时间至少 2 年的所有患者。患者按适应证分为 3 组：GHOA、肩袖撕裂性关节炎（CTA）和 MCT。收集基线人口统计学特征，以确定 3 组间的差异。测量术前和术后的临床结果，包括主动活动范围、美国肩肘外科医生（ASES）评分、单项评估数字评分和视觉模拟评分疼痛评分。采用多元线性回归分析确定术后 ASES 评分的独立预测因素。
共纳入 625 例患者（GHOA 组 383 例、CTA 组 164 例和 MCT 组 78 例），平均随访时间为 33.4 个月。GHOA 组患者的 ASES 评分（85.6±15.7 与 CTA 组的 76.6±20.8[P<0.001]和 MCT 组的 75.9±19.9[P<0.001]）、单项评估数字评分（86±20.9 与 CTA 组的 76.7±24.1[P<0.001]和 MCT 组的 74.2±25.3[P<0.001]）和视觉模拟评分疼痛评分（中位数[四分位数间距]，0.0[0.0-1.0]与 CTA 组的 0.0[0.0-2.0][P<0.001]和 MCT 组的 0.0[0.0-2.0][P<0.001]）术后均较好。与其他适应证相比，GHOA 组术后主动前屈（P<0.001）和主动外旋改善（P<0.001）最大。多元线性回归显示，与术后 ASES 评分独立相关的因素包括 GHOA 诊断（β系数，7.557[P<0.001]）、术前 ASES 评分（β系数，0.114[P=0.009]）、女性（β系数，-4.476[P=0.002]）、既往手术史（β系数，-3.957[P=0.018]）和术后并发症（β系数，-13.550[P<0.001]）。
与 CTA 和无关节炎的 MCT 相比，RTSA 治疗 GHOA 通常具有更好的患者报告和功能结果。需要长期随访以确定这种疗效差异的持久影响。
