Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA.
Andrews Research and Education Foundation, Gulf Breeze, FL, USA.
Arch Orthop Trauma Surg. 2024 May;144(5):1925-1935. doi: 10.1007/s00402-024-05276-8. Epub 2024 Mar 25.
Patients who undergo reverse total shoulder arthroplasty (RTSA) are getting younger with greater function expectations. This retrospective, longitudinal study of prospectively collected data compared perceived shoulder function and strength, active shoulder mobility, radiographic evidence of scapular notching, and implant survival over the initial 2-years post-RTSA among patient groups who received either standard central fixation point liner and glenoid baseplate implants, or lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants.
Patients who underwent primary RTSA using standard central fixation point liner and glenoid baseplate implants (Group 1, n = 180) were compared with patients who underwent primary RTSA using lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants (Group 2, n = 53) for active shoulder mobility, American Shoulder and Elbow Surgeons (ASES) score, perceived ability to lift 10 lbs (4.5 kg) overhead, radiographic evidence of scapular notching, and implant survival. Data was collected pre-surgery, 6-weeks, 6-months, 1-year, and 2-years post-RTSA (p ≤ 0.05).
More Group 2 patients had more complex B or C Walch glenoid morphology, while Group 1 had more A1 or A2 types (p ≤ 0.001). Group 2 had greater active shoulder flexion at 6-months, 1-year, and 2-years (p ≤ 0.018) and external rotation (in adduction) at 6-months and 2-years (p ≤ 0.004) compared to Group 1, with higher ASES scores at 6-months and 2-years (p ≤ 0.026) (with small-to-medium effect sizes), and with more patients meeting or exceeding the minimal clinically important difference (MCID) at 2-years (p = 0.045) and patient acceptable symptomatic state (PASS) levels at 6-months, 1-year and 2-years (p ≤ 0.045). Scapular notching was identified in six of 53 (11.3%) Group 2 patients and in 32 of 180 (17.7%) Group 1 patients. Group 1 patients had more grade 2 or greater scapular notching grades compared to Group 2 (p = 0.04). Implant survival was comparable with Group 1 = eight of 180 (4.4%) and Group 2 = 1 of 53 (1.9%) of patients requiring removal for 95.6% and 98.1% implant survival, respectively.
Limited scapular notching and excellent implant survival was observed in both groups. Despite including individuals with more complex glenoid deficiency, patients receiving the lower size profile implants generally displayed better active shoulder mobility and perceived shoulder function compared to those who received standard implants. These patients also more frequently met or exceeded the MCID by 2-years post-RTSA and PASS levels by 6-months, 1-year, and 2-years post-RTSA, with lower scapular notching grades.
Retrospective comparative study.
接受反向全肩关节置换术（RTSA）的患者年龄越来越小，对功能的期望也越来越高。本研究前瞻性收集数据进行回顾性纵向研究，比较了两组患者在 RTSA 术后最初 2 年的肩部功能和力量感知、主动肩部活动度、肩胛切迹的放射学证据以及植入物存活率，其中一组患者接受标准中央固定点衬垫和肩胛盂基底部植入物（第 1 组，n=180），另一组患者接受较小尺寸的迷你肱骨托盘与偏心关节轴选项和迷你增强肩胛盂基底部植入物（第 2 组，n=53）。
比较接受标准中央固定点衬垫和肩胛盂基底部植入物（第 1 组，n=180）的患者与接受较小尺寸的迷你肱骨托盘与偏心关节轴选项和迷你增强肩胛盂基底部植入物（第 2 组，n=53）的患者的主动肩部活动度、美国肩肘外科医生（ASES）评分、感知举起 10 磅（4.5 公斤）重物的能力、肩胛切迹的放射学证据以及植入物存活率。数据在术前、术后 6 周、6 个月、1 年和 2 年（p≤0.05）收集。
第 2 组患者中，更多的患者具有更复杂的 B 或 C 型 Walch 肩胛盂形态，而第 1 组患者则具有更多的 A1 或 A2 类型（p≤0.001）。与第 1 组相比，第 2 组患者在术后 6 个月、1 年和 2 年时的主动肩部屈曲（p≤0.018）和外展（内收）（p≤0.004）更大，术后 6 个月和 2 年时的 ASES 评分更高（p≤0.026）（具有小到中等的效应大小），并且在术后 2 年时更多的患者达到或超过最小临床重要差异（MCID）（p=0.045）和患者可接受的症状状态（PASS）水平（p≤0.045）。第 2 组 53 例（11.3%）患者中有 6 例发生肩胛切迹，第 1 组 180 例（17.7%）患者中有 32 例发生肩胛切迹。与第 2 组相比，第 1 组患者肩胛切迹更严重，更多为 2 级或更严重的肩胛切迹分级（p=0.04）。两组患者的植入物存活率相当，第 1 组中有 8 例（4.4%）和第 2 组中有 1 例（1.9%）患者因需要取出植入物，其植入物存活率分别为 95.6%和 98.1%。
两组患者均观察到有限的肩胛切迹和良好的植入物存活率。尽管第 2 组患者包括更多具有复杂肩胛盂缺损的患者，但接受较小尺寸植入物的患者通常比接受标准植入物的患者具有更好的主动肩部活动度和感知肩部功能。这些患者在 RTSA 术后 2 年时也更频繁地达到或超过 MCID，在术后 6 个月、1 年和 2 年时达到或超过 PASS 水平，并且肩胛切迹分级较低。
回顾性比较研究。
