Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Orthopedic Surgery, Beaumont Health, Royal Oak, MI, USA.
J Shoulder Elbow Surg. 2024 May;33(5):1200-1208. doi: 10.1016/j.jse.2023.10.006. Epub 2023 Nov 20.
Reverse total shoulder arthroplasty (RTSA) is increasingly used as a treatment modality for various pathologies. The purpose of this review is to identify preoperative risk factors associated with loss of internal rotation (IR) after RTSA.
A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ovid MEDLINE, Ovid Embase, and Scopus were queried. The inclusion criteria were as follows: articles in English language, minimum 1-year follow-up postoperatively, study published after 2012, a minimum of 10 patients in a series, RTSA surgery for any indication, and explicitly reported IR. The exclusion criteria were as follows: articles whose full text was unavailable or that were unable to be translated to English language, a follow-up of less than 1 year, case reports or series of less than 10 cases, review articles, studies in which tendon transfers were performed at the time of surgery, procedures that were not RTSA, and studies in which the range of motion in IR was not reported.
The search yielded 3792 titles, and 1497 duplicate records were removed before screening. Ultimately, 16 studies met the inclusion criteria with a total of 5124 patients who underwent RTSA. Three studies found that poor preoperative functional IR served as a significant risk factor for poor postoperative IR. Eight studies addressed the impact of subscapularis, with 4 reporting no difference in IR based on subscapularis repair and 4 reporting significant improvements with subscapularis repair. Among studies with sufficient power, BMI was found to be inversely correlated with degree of IR after RTSA. Preoperative opioid use was found to negatively affect IR. Other studies showed that glenoid retroversion, component lateralization, and individualized component positioning affected postoperative IR.
This study found that preoperative IR, individualized implant version, preoperative opioid use, increased body mass index and increased glenoid lateralization were all found to have a significant impact on IR after RTSA. Studies that analyzed the impact of subscapularis repair reported conflicting results.
反向全肩关节置换术（RTSA）作为一种治疗多种疾病的方法，应用日益广泛。本综述旨在确定 RTSA 后内旋（IR）丧失的术前相关危险因素。
采用系统评价的首选报告项目（PRISMA）指南进行系统评价。检索 Ovid MEDLINE、Ovid Embase 和 Scopus。纳入标准为：英文文献、术后至少 1 年随访、2012 年后发表的研究、系列中至少 10 例患者、用于任何适应证的 RTSA 手术以及明确报告 IR。排除标准为：无法获取全文或无法翻译为英文的文章、随访时间少于 1 年、病例报告或少于 10 例的系列研究、综述文章、手术时进行肌腱转位的研究、非 RTSA 手术的研究以及未报告 IR 范围的研究。
检索得到 3792 篇标题，筛选前剔除了 1497 篇重复记录。最终，16 项研究符合纳入标准，共有 5124 例患者接受了 RTSA。有 3 项研究发现，术前功能 IR 差是术后 IR 差的显著危险因素。8 项研究探讨了肩胛下肌的影响，其中 4 项研究报告肩胛下肌修复与 IR 无差异，4 项研究报告肩胛下肌修复后 IR 显著改善。在有足够效能的研究中，BMI 与 RTSA 后 IR 呈负相关。术前使用阿片类药物被发现会对 IR 产生负面影响。其他研究表明，肩胛盂后倾、假体侧方化和个体化假体定位会影响术后 IR。
本研究发现，术前 IR、个体化假体版本、术前阿片类药物使用、BMI 增加和肩胛盂侧方化增加均对 RTSA 后 IR 有显著影响。分析肩胛下肌修复影响的研究报告结果存在矛盾。
