Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
J Shoulder Elbow Surg. 2024 Oct;33(10):2306-2313. doi: 10.1016/j.jse.2024.03.053. Epub 2024 May 14.
The purpose of this study is to systematically review the evidence in the literature to ascertain the functional outcomes, range of motion (ROM), and complication and reoperation rates after revision reverse shoulder arthroplasty (RSA) for a failed primary total shoulder arthroplasty (TSA) or hemiarthroplasty (HA).
Two independent reviewers performed the literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Studies were included if they reported clinical outcomes for revision RSA for a failed primary TSA or HA.
Our review found 23 studies including 1041 shoulders (627 TSA and 414 HA) meeting our inclusion criteria. The majority of patients were female (66.1%), with an average age of 69.0 years (range: 39-93 years) and a mean follow-up of 46.3 months. American Shoulder and Elbow Surgeons and visual analog scale pain scores improved from 32.6 to 61.9 and 6.7 to 2.7, respectively. ROM results include forward flexion, abduction, and external rotation, which improved from 59.4° to 107.7°, 50.7° to 104.4°, and 19.8° to 26.3°, respectively. Only 1 of the 10 studies reporting internal rotation found a statistically significant difference, with the mean internal rotation improving from S1-S3 preoperatively to L4-L5 postoperatively for patients undergoing HA. The overall complication rate and reoperation rate were 23.4% and 12.5%, respectively. The most common complications were glenoid component loosening (6.0%), fracture (periprosthetic, intraoperative, or other scapula fractures) (n = 4.7%), and infection (n = 3.3%).
Revision RSA for a failed primary TSA and HA has been shown to result in excellent functional outcomes and improved ROM, suggesting that patients who have failed TSA or HA may benefit from a revision RSA.
本研究旨在系统回顾文献中的证据，以确定初次全肩关节置换术（TSA）或人工半肩关节置换术（HA）失败后行翻修反肩关节置换术（RSA）的功能结果、活动范围（ROM）以及并发症和再手术率。
两名独立的审查员根据系统评价和荟萃分析的首选报告项目指南，使用 EMBASE、MEDLINE 和 Cochrane 图书馆数据库进行文献检索。如果研究报告了初次 TSA 或 HA 失败后行翻修 RSA 的临床结果，则纳入研究。
我们的综述发现了 23 项研究，包括 1041 例肩部（627 例 TSA 和 414 例 HA）符合纳入标准。大多数患者为女性（66.1%），平均年龄 69.0 岁（范围：39-93 岁），平均随访时间为 46.3 个月。美国肩肘外科医师协会和视觉模拟评分疼痛从 32.6 分提高到 61.9 分，从 6.7 分提高到 2.7 分。ROM 结果包括前屈、外展和外旋，分别从 59.4°提高到 107.7°，从 50.7°提高到 104.4°，从 19.8°提高到 26.3°。仅 10 项研究中有 1 项报告了内旋，发现有统计学意义的差异，术后内旋从术前 S1-S3 提高到术后 L4-L5，接受 HA 的患者。总的并发症发生率和再手术率分别为 23.4%和 12.5%。最常见的并发症是肩胛盂组件松动（6.0%）、骨折（假体周围、术中或其他肩胛骨骨折）（n=4.7%）和感染（n=3.3%）。
初次 TSA 和 HA 失败后行翻修 RSA 已被证明可获得优异的功能结果和改善的 ROM，表明初次 TSA 或 HA 失败的患者可能受益于翻修 RSA。
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