Department of Orthopedics, Apollo HealthCity Hospital, Jubilee Hills, Hyderabad, India.
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
J Shoulder Elbow Surg. 2024 Dec;33(12):2604-2611. doi: 10.1016/j.jse.2024.03.052. Epub 2024 May 14.
The influence of position of the humeral tray (inlay or onlay) on clinical outcomes in reverse shoulder arthroplasty (RSA) is a topic of debate. The purpose of this study was to compare clinical and radiographic outcomes of patients with cuff tear arthropathy treated with RSA systems with inlay or onlay humeral tray design, similar neck-shaft angles, and lateralized glenospheres.
This was a retrospective study of prospectively obtained data from 1 tertiary care center. We identified all patients who underwent primary RSA between 2009 and 2017 (N = 511). We included 102 patients with diagnosed cuff tear arthropathy treated with RSA prostheses with a lateralized glenosphere and 135° neck-shaft angle (with either an inlay or onlay humeral tray design) who had a minimum of 2 years of follow-up (mean, 44 months; range, 24-125 months). Sixty-three patients (62%) had an inlay humeral tray (inlay group) and 39 (38%) had an onlay tray (onlay group). All patients underwent preoperative and postoperative evaluations, including measures of patient-reported outcomes (PROs), shoulder range of motion (ROM) testing, and radiographic imaging. Clinical relevance of changes in PROs and ROM was evaluated using published values for minimal clinically important differences.
The 2 groups did not differ by demographic characteristics except for a higher proportion of women in the inlay group (75%) than in the onlay group (56%) (P = .04). Preoperative PROs and ROM were not significantly different between groups. At final follow-up, PROs and ROM were not different between groups in terms of statistical significance or clinical relevance. We found no significant differences in the rate of baseplate loosening (inlay, 3.2% vs. onlay, 5.1%, P = .63), revision surgery (inlay, 0% vs. onlay 5.1%, P = .07), acromial stress fracture (inlay, 3.2% vs. onlay, 5.1%, P = .63), prosthesis dislocation (inlay, 0% vs. onlay, 2.6%, P = .20), or scapular notching (inlay, 21% vs. onlay, 7.7%, P = .08).
At 2-year minimum follow-up, the position of the humeral tray in RSA prostheses (either inlay or onlay) for cuff tear arthropathy was not associated with PROs, shoulder ROM, or rates of complications, including baseplate loosening, acromial stress fracture, and scapular notching.
在反肩关节置换术（RSA）中，肱骨托的位置（嵌入式或覆盖式）对临床结果的影响是一个有争议的话题。本研究的目的是比较采用嵌入式或覆盖式肱骨托设计、类似的颈干角和外侧化肱骨头的 RSA 系统治疗肩袖撕裂性关节炎患者的临床和影像学结果。
这是对一家三级护理中心前瞻性获得的数据进行的回顾性研究。我们确定了 2009 年至 2017 年间接受 RSA 的所有患者（N=511）。我们纳入了 102 例诊断为肩袖撕裂性关节炎的患者，他们接受了 RSA 假体治疗，肱骨头外侧化，颈干角为 135°（采用嵌入式或覆盖式肱骨托设计），并至少随访 2 年（平均 44 个月；范围，24-125 个月）。63 例患者（62%）采用嵌入式肱骨托（嵌入式组），39 例患者（38%）采用覆盖式肱骨托（覆盖式组）。所有患者均接受术前和术后评估，包括患者报告的结果（PROs）、肩部活动范围（ROM）测试和影像学检查。使用发表的最小临床重要差异值评估 PROs 和 ROM 变化的临床意义。
两组患者除了覆盖组女性比例（75%）高于嵌入式组（56%）（P=.04）外，其他人口统计学特征无差异。两组患者术前 PROs 和 ROM 无显著差异。最终随访时，两组患者在 PROs 和 ROM 方面无统计学意义或临床意义上的差异。我们发现，在基底松动率（嵌入式，3.2%比覆盖式，5.1%，P=.63）、翻修手术率（嵌入式，0%比覆盖式，5.1%，P=.07）、肩峰应力性骨折率（嵌入式，3.2%比覆盖式，5.1%，P=.63）、假体脱位率（嵌入式，0%比覆盖式，2.6%，P=.20）或肩胛切迹率（嵌入式，21%比覆盖式，7.7%，P=.08）方面，两组间无显著差异。
在至少 2 年的随访中，对于肩袖撕裂性关节炎，RSA 假体中肱骨托的位置（嵌入式或覆盖式）与 PROs、肩部 ROM 或并发症发生率（包括基底松动、肩峰应力性骨折和肩胛切迹）无关。
