Ranieri Riccardo, Cointat Caroline, Lacouture-Suarez Juan-David, Boileau Pascal
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Pôle Santé Saint Jean, Cagnes-sur-Mer, France.
J Shoulder Elbow Surg. 2025 Mar;34(3):726-738. doi: 10.1016/j.jse.2024.06.028. Epub 2024 Aug 13.
Posterior humeral subluxation (PHS) in B2 and B3 glenoid is a cause of asymmetric long-term stress on the glenoid and the potential reason for glenoid loosening in anatomic total shoulder arthroplasty and painful glenoid erosion in hemiarthroplasty with metallic heads. We hypothesized that corrective and concentric (C2) reaming of the glenoid associated with pyrocarbon hemiarthroplasty (HA-PYC) could improve the centering of the humeral head and decrease the risk of persistent painful glenoid erosion in young and active patients with B2 and B3 glenoid.
Between 2014 and 2020, 41shoulders (in 35 patients, mean age of 57.9 years) underwent HA-PYC combined with C2 reaming for B2 (n = 30) or B3 (n = 11) osteoarthritis. Patients were prospectively followed with computed tomography (CT) scans performed preoperatively, immediate postoperatively, and at last follow-up (>2 years). The primary outcomes were 3D-corrected CT scan measurements of glenoid version, PHS, and progression of glenoid erosion. Secondary outcomes included functional outcome scores, return to activities, and revision rate and complications.
At a mean follow-up of 4.5 years (2-9.5 years), the prosthesis survival was 95% (39 of 41). No patient has been reoperated for painful glenoid erosion. The mean glenoid retroversion decreased from 17.1° ± 7.5° preoperatively to 8.3° ± 8.2° at last follow-up (P = .001), and the mean PHS from 74% to 56.5% (P = .001) based on the scapular plane and from 59.9% to 50.3% based on the glenoid plane. The humeral head was recentered in 97% according to the glenoid surface and 71% according to the scapular plane. Correction of PHS in the scapular plane was highly correlated to correction of glenoid retroversion (P < .001). CT scan measurements showed that the average total medialization was 3.7 ± 3.2 mm (2.0 ± 1.8 mm due to reaming and only 1.7 ± 2.4 mm due to erosion). The adjusted Constant Score increased from 43% ± 13% to 97% ± 16% and the Subjective Shoulder Value from 38% ± 14% to 84% ± 12% (P < .001). Overall, 84% of active patients returned to work, and all patients returned to sports.
In B2 and B3 glenoid arthritis, corrective, concentric glenoid reaming combined with HA-PYC improves centering of the humeral head and shows a low risk of painful glenoid erosion at midterm follow-up. The combined procedure results in excellent functional outcomes and high prosthesis survivorship at midterm follow-up. HA-PYC and C2 reaming of the glenoid is an alternative shoulder arthroplasty for young/active patients with type B glenoid osteoarthritis who want to return to work or sports practice.
B2和B3型肩胛盂的肱骨头后脱位（PHS）是肩胛盂长期不对称应力的一个原因，也是解剖型全肩关节置换术中肩胛盂松动以及金属头半关节置换术中肩胛盂疼痛性侵蚀的潜在原因。我们假设，与热解碳半关节置换术（HA-PYC）相关的肩胛盂矫正和同心（C2）扩孔可以改善年轻活跃的B2和B3型肩胛盂患者的肱骨头对合，并降低持续性肩胛盂疼痛性侵蚀的风险。
2014年至2020年期间，41例肩部（35例患者，平均年龄57.9岁）因B2型（n = 30）或B3型（n = 11）骨关节炎接受了HA-PYC联合C2扩孔治疗。对患者进行前瞻性随访，术前、术后即刻及末次随访（>2年）均行计算机断层扫描（CT）。主要结局指标为肩胛盂版本、PHS及肩胛盂侵蚀进展的三维校正CT扫描测量值。次要结局指标包括功能结局评分、恢复活动情况、翻修率及并发症。
平均随访4.5年（2 - 9.5年），假体生存率为95%（41例中的39例）。没有患者因肩胛盂疼痛性侵蚀而再次手术。末次随访时，平均肩胛盂后倾从术前的17.1°±7.5°降至8.3°±8.2°（P = 0.001），基于肩胛平面的平均PHS从74%降至56.5%（P = 0.001），基于肩胛盂平面的从59.9%降至50.3%。根据肩胛盂表面，97%的肱骨头实现了重新对合，根据肩胛平面为71%。肩胛平面PHS的矫正与肩胛盂后倾的矫正高度相关（P < 0.001）。CT扫描测量显示，平均总内移为3.7±3.2 mm（扩孔导致2.0±1.8 mm，侵蚀导致仅1.7±2.4 mm）。调整后的Constant评分从43%±13%提高到97%±16%，主观肩关节评价值从38%±14%提高到84%±12%（P < 0.001）。总体而言，84%的活跃患者恢复工作，所有患者都恢复了运动。
在B2和B3型肩胛盂关节炎中，矫正性、同心性肩胛盂扩孔联合HA-PYC可改善肱骨头对合，且在中期随访时肩胛盂疼痛性侵蚀风险较低。联合手术在中期随访时可带来优异的功能结局和较高的假体生存率。HA-PYC和肩胛盂C2扩孔是希望恢复工作或运动的B型肩胛盂骨关节炎年轻/活跃患者的一种肩关节置换术替代方案。
