DeBernardis Dennis, Donnelly David, Bahel Aditya, Favorito Paul
Division of Shoulder and Elbow Surgery, The Rothman Orthopaedic Institute, Jersey City, NJ, USA.
Division of Shoulder and Elbow Surgery, The Christ Hospital, Cincinnati, OH, USA.
J Shoulder Elbow Surg. 2025 Jan;34(1):51-61. doi: 10.1016/j.jse.2024.03.038. Epub 2024 May 6.
The purpose of this study is to report the minimum 5-year clinical and radiographic outcomes of patients undergoing anatomic total shoulder arthroplasty (aTSA) with a posteriorly augmented glenoid component.
Thirty-five shoulders with minimum 5-year follow-up underwent aTSA using a posteriorly augmented glenoid component for the treatment of glenohumeral osteoarthritis with posterior glenoid bone loss. Clinical outcomes included range of motion, visual analog scale (VAS) for pain, and patient-reported outcomes scores. Radiographs and computed tomography scans were obtained to assess glenoid morphology, retroversion, and central peg osseous integration via Wirth score, Lazarus scores, and Yian scores. Postoperative outcomes were measured at minimum 2- and 5-year follow-up. Kaplan-Meier survival analysis was calculated.
Two patients experienced prosthetic instability requiring revision, leaving 33 shoulders with an average follow-up of 6.6 years. Average preoperative glenoid retroversion was 21.6°. A significant improvement in pain, range of motion, and patient-reported outcomes score was noted at minimum 2- and 5-year follow-up. In addition, VAS pain, American Shoulder and Elbow Surgeons, and Quick Disabilities of the Arm, Shoulder, and Hand scores improved between minimum 2- and 5-year follow-up. The average Lazarus and Yian scores at final follow-up were 0.73 and 2.6, respectively. There was an increase in Lazarus score and a decrease in Wirth score between 2- and 5-year follow-up. A significant correlation was identified between VAS pain scores and both Lazarus and Wirth scores. Survivorship free from revision was 92% at 8.8 years postoperatively.
Midterm results of aTSA with a posteriorly augmented, stepped glenoid component demonstrate sustained improvements in clinical outcomes with low rates of radiographic loosening. Continued improvement in pain and function, as well as a minor progression of radiographic osteolysis, may be expected between 2- and 5-year follow-up. In addition, the severity of radiographic loosening correlates with subjective pain levels.
本研究旨在报告采用后方增强型盂部件的解剖型全肩关节置换术（aTSA）患者至少5年的临床和影像学结果。
35例接受至少5年随访的肩关节接受了aTSA，使用后方增强型盂部件治疗伴有后方盂骨丢失的盂肱关节骨关节炎。临床结果包括活动范围、疼痛视觉模拟量表（VAS）以及患者报告的结果评分。获取X线片和计算机断层扫描以通过Wirth评分、Lazarus评分和Yian评分评估盂形态、后倾以及中心固定钉的骨整合情况。在至少2年和5年随访时测量术后结果。计算Kaplan-Meier生存分析。
2例患者出现假体不稳定需要翻修，剩余33例肩关节平均随访6.6年。术前平均盂后倾为21.6°。在至少2年和5年随访时，疼痛、活动范围以及患者报告的结果评分均有显著改善。此外，在至少2年和5年随访之间，VAS疼痛评分、美国肩肘外科医师协会评分以及上肢、肩部和手部快速残疾评分均有所改善。末次随访时平均Lazarus评分和Yian评分分别为0.73和2.6。在2年和5年随访之间，Lazarus评分增加，Wirth评分降低。VAS疼痛评分与Lazarus评分和Wirth评分之间均存在显著相关性。术后8.8年翻修-free生存率为92%。
采用后方增强型阶梯状盂部件的aTSA中期结果显示临床结果持续改善，影像学松动率低。在2年和5年随访之间，疼痛和功能可能会持续改善，影像学骨溶解可能会有轻微进展。此外，影像学松动的严重程度与主观疼痛水平相关。
