Patel Akshar V, Durisek George R, Katayama Erryk S, Iyer Amogh I, Haber Jordan, Cvetanovich Gregory L, Bishop Julie Y, Rauck Ryan C
Department of Orthopedic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Orthopedic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
J Shoulder Elbow Surg. 2025 Mar;34(3):778-784. doi: 10.1016/j.jse.2024.05.041. Epub 2024 Jul 19.
Solid organ transplant (SOT) recipients are commonly prescribed immunosuppressive therapies which may predispose patients to higher infection and complication rates following total shoulder arthroplasty. This article aims to analyze the effects SOT and subsequent immunosuppressive regimens have on the functional and patient-reported outcomes of total shoulder arthroplasties.
A single institution, multisurgeon retrospective case-control study investigating the functional and patient-reported outcomes of shoulder arthroplasty after SOT was conducted between the years of 2010 and 2020. To be included in the study, patients must have undergone SOT prior to primary total shoulder arthroplasty. A 4:1 match-paired control group lacking SOT prior to arthroplasty was then constructed. Thirty-four SOT patients (18 males and 16 females) and 136 control patients (77 male and 59 female) were included in the study. Patients were analyzed who underwent SOT prior to shoulder arthroplasty, with outcomes compared to controls that only underwent arthroplasty. The primary outcomes include range of motion and strength in forward elevation, external rotation, and internal rotation, and patient reported outcomes.
There was no significant difference in improvement for range of motion and strength between the 2 cohorts, but within each cohort, improvement was statistically significant. In the SOT patients, forward elevation improved by 56° ± 52°, external rotation increased by 13° ± 20°, and internal rotation increased by 2 vertebral levels. In the non-SOT patients, forward elevation improved by 45° ± 51°, external rotation increased by 16° ± 25°, and internal rotation increased by 3 vertebral levels. SOT patients had equivocal visual analog scale pain and Simple Shoulder Test scores but lower American Shoulder and Elbow Surgeons (59 ± 13 vs. 79 ± 2; P = .002) and SANE (61 ± 30 vs. 84 ± 17; P < .001) scores than non-SOT patients. Complication rates were not significantly higher in the SOT group (15% vs. 6%; P = .05), but incidence of surgical revisions was not significantly different (SOT = 3%; non-SOT = 5%; P = .59).
Shoulder arthroplasty is a safe, effective surgical intervention for improving shoulder function in patients with a history of SOT. Despite being on chronic immunosuppressive regimens, our solid organ transplants had comparable clinical outcomes and revision rates, but higher complication rates.
实体器官移植（SOT）受者通常会接受免疫抑制治疗，这可能使患者在全肩关节置换术后更容易出现感染和并发症。本文旨在分析SOT及后续免疫抑制方案对全肩关节置换术功能和患者报告结局的影响。
在2010年至2020年间进行了一项单机构、多外科医生的回顾性病例对照研究，调查SOT后肩关节置换术的功能和患者报告结局。纳入研究的患者必须在初次全肩关节置换术前接受过SOT。然后构建一个在关节置换术前未接受SOT的4:1匹配对照组。本研究纳入了34例SOT患者（18例男性和16例女性）和136例对照患者（77例男性和59例女性）。分析了在肩关节置换术前接受SOT的患者，并将结果与仅接受关节置换术的对照组进行比较。主要结局包括前屈、外旋和内旋的活动范围和力量，以及患者报告的结局。
两组之间在活动范围和力量改善方面无显著差异，但在每个队列中，改善具有统计学意义。在SOT患者中，前屈改善了56°±52°，外旋增加了13°±20°，内旋增加了2个椎体节段。在非SOT患者中，前屈改善了45°±51°，外旋增加了16°±25°，内旋增加了3个椎体节段。SOT患者的视觉模拟评分疼痛和简单肩关节测试评分不明确，但美国肩肘外科医生协会评分（59±13对79±2；P = 0.002）和SANE评分（61±30对84±17；P < 0.001）低于非SOT患者。SOT组的并发症发生率没有显著更高（15%对6%；P = 0.05），但手术翻修率没有显著差异（SOT = 3%；非SOT = 5%；P = 0.59）。
肩关节置换术是改善有SOT病史患者肩部功能的一种安全、有效的手术干预措施。尽管接受慢性免疫抑制治疗，但我们的实体器官移植患者具有可比的临床结局和翻修率，但并发症发生率更高。
