Department of Surgery, University of Auckland, Grafton, Auckland, New Zealand; Department of Orthopedic Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand.
Department of Surgery, University of Auckland, Grafton, Auckland, New Zealand.
J Shoulder Elbow Surg. 2024 Sep;33(9):1946-1954. doi: 10.1016/j.jse.2024.01.024. Epub 2024 Feb 28.
Recently, the indication of reverse total shoulder arthroplasty (RTSA) has expanded beyond rotator cuff arthropathy to include treatment of complex acute proximal humeral fracture (PHF). Limited previous studies have compared the long-term clinical and functional outcomes of patients undergoing RTSA for PHF vs. elective indications for degenerative conditions. The purpose of this study was to compare implant survivorship, reasons for revision and functional outcomes in patients undergoing RTSA for acute PHF with those undergoing elective RTSA in a population-based cohort study.
Prospectively collected data from the New Zealand Joint Registry from 1999 to 2021 and identified 6862 patients who underwent RTSA. Patients were categorized by preoperative indication, including PHF (10.8%), rotator cuff arthropathy (RCA) (44.5%), osteoarthritis (OA) (34.1%), rheumatoid arthritis (RA) (5.5%), and old traumatic sequelae (5.1%). Revision-free implant survival and functional outcomes (Oxford Shoulder Scores [OSSs] at the 6-month, 5-year, and 10-year follow-ups) were adjusted by age, sex, American Society of Anesthesiologists class, and surgeon experience and compared.
Revision-free implant survival at 10 years for RTSA for PHF was 97.3%, compared with 96.1%, 93.7%, 92.8%, and 91.3% for OA, RCA, RA and traumatic sequelae, respectively. When compared with RTSA for PHF, the adjusted risk of revision was significantly higher for traumatic sequelae (hazard ratio = 2.3, P = .023) but not for other elective indications. The most common reason for revision in the PHF group was dislocation or instability (42.9%), which was similar to the OA (47.6%) and traumatic sequelae (33.3%) groups. At 6 months post-surgery, OSSs were significantly lower for the PHF group compared with the RCA, OA, and RA groups (31.1 vs. 35.6, 37.7, and 36.5, respectively, P < .001), and similar to traumatic sequelae (31.7, P = .431). At 5 years, OSSs were only significantly lower for PHF compared with OA (37.4 vs. 41.0, P < .001) and there was no difference between the PHF and other groups. At 10 years, there were no significant differences between groups.
RTSA for PHF demonstrated reliable long-term survivorship and functional outcomes compared with elective indications. Despite lower functional outcomes in the early postoperative period for the PHF group, implant survivorship was similar in patients undergoing RTSA for the primary indication of acute PHF compared with RCA, OA, and RA and superior compared to the primary indication of traumatic sequelae.
最近，反向全肩关节置换术（RTSA）的适应证已超出肩袖关节炎，包括治疗复杂的急性肱骨近端骨折（PHF）。先前的有限研究比较了接受 RTSA 治疗 PHF 与退行性疾病的选择性适应证的患者的长期临床和功能结果。本研究的目的是比较在基于人群的队列研究中，因急性 PHF 而行 RTSA 与因选择性适应证而行 RTSA 的患者的植入物存活率、翻修原因和功能结果。
从 1999 年至 2021 年，前瞻性地从新西兰关节登记处收集数据，并确定了 6862 例接受 RTSA 的患者。根据术前适应证将患者分为 PHF（10.8%）、肩袖关节炎（RCA）（44.5%）、骨关节炎（OA）（34.1%）、类风湿关节炎（RA）（5.5%）和陈旧性创伤后遗症（5.1%）。调整年龄、性别、美国麻醉医师协会分级和外科医生经验后，比较了 RTSA 治疗 PHF 的无翻修植入物存活率和功能结果（6 个月、5 年和 10 年随访时的牛津肩部评分[OSSs]）。
PHF 患者接受 RTSA 治疗的 10 年无翻修植入物存活率为 97.3%，而 OA、RCA、RA 和创伤后遗症的相应存活率分别为 96.1%、93.7%、92.8%和 91.3%。与 RTSA 治疗 PHF 相比，创伤后遗症的调整后的翻修风险显著更高（风险比=2.3，P=0.023），但其他选择性适应证并非如此。PHF 组最常见的翻修原因是脱位或不稳定（42.9%），与 OA（47.6%）和创伤后遗症（33.3%）组相似。术后 6 个月，PHF 组的 OSS 明显低于 RCA、OA 和 RA 组（分别为 31.1、35.6、37.7 和 36.5，P<0.001），与创伤后遗症组相似（31.7，P=0.431）。5 年后，仅 PHF 组的 OSS 与 OA 组（分别为 37.4 和 41.0，P<0.001）之间存在显著差异，而 PHF 组与其他组之间无差异。10 年后，各组之间无显著差异。
与选择性适应证相比，PHF 患者的 RTSA 治疗具有可靠的长期存活率和功能结果。尽管 PHF 组在术后早期的功能结果较低，但因急性 PHF 为主要适应证而接受 RTSA 治疗的患者的植入物存活率与 RCA、OA 和 RA 相似，且优于创伤后遗症的主要适应证。
