Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA; Research Development Unit, Department of Orthopaedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA.
J Shoulder Elbow Surg. 2024 Jun;33(6S):S104-S110. doi: 10.1016/j.jse.2024.03.003. Epub 2024 Mar 12.
Reverse total shoulder arthroplasty (RSA) has been increasingly utilized for a variety of shoulder pathologies that are difficult to treat with anatomical total shoulder arthroplasty (TSA). Few studies have compared the outcomes of TSA vs. RSA in patients with cuff intact glenohumeral osteoarthritis and poor preoperative forward elevation. This study aimed to determine whether there is a difference in functional outcomes and postoperative range of motion (ROM) between TSA and RSA in these patients.
This retrospective cohort study included 116 patients who underwent RSA or TSA between 2013 and 2022 for the treatment of rotator cuff intact primary osteoarthritis with restricted preoperative forward flexion (FF) and a minimum 1-year follow-up. Each arthroplasty group was divided into 2 subgroups: patients with preoperative FF between 91° and 120° or FF lower than or equal to 90°. Patients' clinical outcomes, including active ROM, American Shoulder and Elbow Surgeons score, visual analog scale for pain, and subjective shoulder value were collected. Clinical and radiographic complications were evaluated.
There was no significant difference between RSA and TSA in terms of sex (58.3% male vs. 62.2% male, P = .692), or follow-up duration (20.1 months vs. 17.7 months, P = .230). However, the RSA cohort was significantly older (72.0 ± 8.2 vs. 65.4 ± 10.6, P = .012) and weaker in FF and (ER) before surgery (P < .001). There was no difference between RSA (57 patients) and TSA (59 patients) in visual analog scale pain score (1.2 ± 2.3 vs. 1.3 ± 2.3, P = .925), subjective shoulder value score (90 ± 15 vs. 90 ± 15, P = .859), or American Shoulder and Elbow Surgeons score (78.4 ± 20.5 vs. 82.1 ± 23.2, P = .476). Postoperative active ROM was statistically similar between RSA and TSA cohorts in FF (145 ± 26 vs. 146 ± 23, P = .728) and ER (39 ± 15 vs. 41 ± 15, P = .584). However, internal rotation was lower in the RSA cohort (P < .001). This was also true in each subgroup. RSA led to faster postoperative FF and ER achievement at 3 months (P < .001). There was no statistically significant difference in complication rates between cohorts.
This study demonstrates that patients with glenohumeral osteoarthritis who have a structurally intact rotator cuff but limited preoperative forward elevation can achieve predictable clinical improvement in pain, ROM, and function after either TSA or RSA. Reverse arthroplasty may be a reliable treatment option in patients at risk for developing rotator cuff failure.
反向全肩关节置换术（RSA）已越来越多地用于治疗各种难以通过解剖全肩关节置换术（TSA）治疗的肩关节炎。很少有研究比较 TSA 和 RSA 在肩袖完整的肩关节炎伴术前前屈受限和前屈活动度差的患者中的疗效。本研究旨在确定在这些患者中，TSA 和 RSA 在功能结果和术后活动度（ROM）方面是否存在差异。
这是一项回顾性队列研究，纳入了 2013 年至 2022 年间因肩袖完整的原发性骨关节炎接受 RSA 或 TSA 治疗的 116 例患者，这些患者术前前屈受限（FF）且至少随访 1 年。每个关节置换组分为 2 个亚组：FF 为 91°-120°或 FF 小于或等于 90°。收集患者的临床结果，包括主动 ROM、美国肩肘外科医生评分、疼痛视觉模拟评分和主观肩部值。评估临床和放射学并发症。
在性别（58.3%男性 vs. 62.2%男性，P=.692）或随访时间（20.1 个月 vs. 17.7 个月，P=.230）方面，RSA 和 TSA 之间没有显著差异。然而，RSA 组患者明显更年长（72.0±8.2 岁 vs. 65.4±10.6 岁，P=.012），术前 FF 和（ER）更弱（P<0.001）。RSA（57 例）和 TSA（59 例）在视觉模拟评分疼痛（1.2±2.3 分 vs. 1.3±2.3 分，P=.925）、主观肩部值（90±15 分 vs. 90±15 分，P=.859）或美国肩肘外科医生评分（78.4±20.5 分 vs. 82.1±23.2 分，P=.476）方面无差异。在 FF（145±26 度 vs. 146±23 度，P=.728）和 ER（39±15 度 vs. 41±15 度，P=.584）方面，RSA 和 TSA 两组患者术后主动 ROM 无统计学差异。然而，RSA 组的内旋角度较低（P<0.001）。在每个亚组中也是如此。RSA 可使患者在术后 3 个月时更快地获得 FF 和 ER（P<0.001）。两组患者的并发症发生率无统计学差异。
本研究表明，对于肩袖完整但术前 FF 受限的肩关节炎患者，无论是接受 TSA 还是 RSA，都可以获得可预测的疼痛、ROM 和功能改善。反向关节置换术可能是肩袖失代偿风险患者的一种可靠治疗选择。
