Hones Keegan M, Hao Kevin A, Buchanan Timothy R, Trammell Amy P, Wright Jonathan O, Wright Thomas W, LaMonica Tyler J, Schoch Bradley S, King Joseph J
Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
College of Medicine, University of Florida, Gainesville, FL, USA.
Clin Shoulder Elb. 2024 Sep;27(3):316-326. doi: 10.5397/cise.2024.00262. Epub 2024 Jul 30.
This study sought to determine if preoperative forward elevation (FE) weakness affects outcomes of anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA).
A retrospective review of a single institution's prospectively collected shoulder arthroplasty database was performed between 2007 and 2020, including 333 aTSAs and 155 rTSAs for primary RCI-GHOA with a minimum 2-year follow-up. Defining preoperative weakness as FE strength ≤4.9 lb (2.2 kg), three cohorts were matched 1:1:1 by age, sex, and follow-up: weak (n=82) to normal aTSAs, weak (n=44) to normal rTSAs, and weak aTSAs (n=61) to weak rTSAs. Compared outcomes included range of motion, outcome scores, and complication and revision rates at latest follow-up.
Weak aTSAs and weak rTSAs achieved similar postoperative outcome measures to normal aTSAs and normal rTSAs, respectively (P>0.05). Compared to weak rTSAs, weak aTSAs achieved superior postoperative passive (P=0.006) and active external rotation (ER) (P=0.014) but less favorable postoperative Shoulder Pain and Disability Index (P=0.032), American Shoulder and Elbow Surgeons (P=0.024), and University of California, Los Angeles scores (P=0.008). Weak aTSAs achieved the minimal clinically important difference and substantial clinical benefit at a lower rate for abduction (P=0.045 and P=0.003) and FE (P=0.011 and P=0.001). Weak aTSAs had a higher revision rate (P=0.025) but a similar complication rate (P=0.291) compared to weak rTSAs.
Patients with RCI-GHOA and preoperative FE weakness obtain postoperative outcomes similar to patients with normal preoperative strength after either aTSA or rTSA. Preoperatively, weak aTSAs achieved greater ER but lower rates of clinically relevant improvement in overhead motion compared to weak rTSAs. Level of evidence: III.
本研究旨在确定术前前屈抬高（FE）无力是否会影响肩袖完整的盂肱关节骨关节炎（RCI-GHOA）患者的解剖型全肩关节置换术（aTSA）和反式全肩关节置换术（rTSA）的疗效。
对2007年至2020年间一家机构前瞻性收集的肩关节置换术数据库进行回顾性分析，纳入333例aTSA和155例rTSA治疗原发性RCI-GHOA的患者，随访至少2年。将术前无力定义为FE力量≤4.9磅（2.2千克），按年龄、性别和随访情况将三组患者1:1:1匹配：FE无力的aTSA患者（n = 82）与FE正常的aTSA患者匹配，FE无力的rTSA患者（n = 44）与FE正常的rTSA患者匹配，FE无力的aTSA患者（n = 61）与FE无力的rTSA患者匹配。比较的结果包括最新随访时的活动范围、疗效评分、并发症和翻修率。
FE无力的aTSA患者和FE无力的rTSA患者术后的疗效指标分别与FE正常的aTSA患者和FE正常的rTSA患者相似（P>0.05）。与FE无力的rTSA患者相比，FE无力的aTSA患者术后被动活动度（P = 0.006）和主动外旋（ER）（P = 0.014）更佳，但术后肩痛和功能障碍指数（P = 0.032）、美国肩肘外科医师协会评分（P = 0.024）和加州大学洛杉矶分校评分（P = 0.008）较差。FE无力的aTSA患者外展（P = 0.045和P = 0.003）和FE（P = 0.011和P = 0.001）达到最小临床重要差异和显著临床获益的比例较低。与FE无力的rTSA患者相比，FE无力的aTSA患者翻修率更高（P = 0.025），但并发症发生率相似（P = 0.291）。
RCI-GHOA且术前FE无力的患者在接受aTSA或rTSA术后，其疗效与术前力量正常的患者相似。术前，与FE无力的rTSA患者相比，FE无力的aTSA患者ER更大，但过头动作的临床相关改善率较低。证据等级：III级。
