Daher Mohammad, Boufadel Peter, Fares Mohamad Y, Lopez Ryan, Goltz Daniel E, Khan Adam Z, Abboud Joseph A
Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Panorama City, CA, USA.
J Shoulder Elbow Surg. 2025 Jan;34(1):190-202. doi: 10.1016/j.jse.2024.06.026. Epub 2024 Aug 12.
Anatomic and reverse total shoulder arthroplasty (RSA) (total shoulder arthroplasty [TSA]) have surged in popularity in recent years. While RSA is Food and Drug Administration approved for cases of rotator cuff tear arthropathy, indications have expanded to include, among others, primary glenohumeral osteoarthritis (GHOA).
PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through November 2023. Inclusion criteria consisted of studies that compared the utility of TSA to that of RSA for the treatment of GHOA with intact rotator cuff with respect to adverse events, patient-reported outcomes, and range of motion (ROM). The Risk Of Bias In Non-randomised Studies - of Interventions tool was used to assess the risk of bias in the included nonrandomized studies, and Review Manager 5.4 was used for statistical analysis. P values <.05 were deemed significant.
Fourteen studies met the above inclusion criteria. Twelve studies reported adverse outcomes, with the RSA group having a lower rate of complications (odds ratio = 0.54, P = .004) and reoperations (odds ratio = 0.31, P < .001) relative to TSA at an average follow-up of 3.4 years. Four studies reported Shoulder Pain and Disability Index and University of California Los Angeles scores, while 5 reported Simple Shoulder Test scores. These studies showed superior Shoulder Pain and Disability Index (P = .040), University of California Los Angeles (P = .006), and Simple Shoulder Test (P = .040) scores among the RSA group. No significant differences were seen with regards to other patient-reported outcomes. Ten studies reported on ROM, and the RSA group had a significantly lower external rotation relative to the TSA group (P < .001) while other ROM parameters did not show statistically significant differences.
The present study provides support for RSA as a reasonable surgical option for patients with GHOA and an intact rotator cuff, with lower rates of adverse events and better outcomes relative to TSA, although at the expense of decreased external rotation. Patient education and counseling is key in order to decide optimal treatment as part of a shared decision-making process, as well as setting appropriate expectations.
解剖型和反向全肩关节置换术（RSA）（全肩关节置换术[TSA]）近年来越来越受欢迎。虽然RSA已获得美国食品药品监督管理局批准用于治疗肩袖撕裂性关节病，但适应症已扩大到包括原发性盂肱骨关节炎（GHOA）等。
截至2023年11月，对PubMed、Cochrane和谷歌学术（第1 - 20页）进行了检索。纳入标准包括比较TSA与RSA在治疗肩袖完整的GHOA方面在不良事件、患者报告结局和活动范围（ROM）方面效用的研究。使用干预性非随机研究中的偏倚风险工具评估纳入的非随机研究中的偏倚风险，并使用Review Manager 5.4进行统计分析。P值<0.05被认为具有统计学意义。
14项研究符合上述纳入标准。12项研究报告了不良结局，在平均3.4年的随访中，RSA组相对于TSA组并发症发生率较低（优势比 = 0.54，P = 0.004），再次手术率较低（优势比 = 0.31，P < 0.001）。4项研究报告了肩痛与功能障碍指数和加利福尼亚大学洛杉矶分校评分，5项研究报告了简单肩关节测试评分。这些研究显示RSA组的肩痛与功能障碍指数（P = 0.040）、加利福尼亚大学洛杉矶分校评分（P = 0.006）和简单肩关节测试评分（P = 0.040）更高。在其他患者报告结局方面未观察到显著差异。10项研究报告了ROM，RSA组相对于TSA组外旋明显更低（P < 0.001），而其他ROM参数未显示统计学显著差异。
本研究支持RSA作为GHOA且肩袖完整患者的合理手术选择，相对于TSA，其不良事件发生率更低，结局更好，尽管代价是外旋减少。患者教育和咨询是作为共同决策过程一部分决定最佳治疗以及设定适当期望的关键。
