Harkin William E, Berreta Rodrigo Saad, Turkmani Amr, Williams Tyler, Scanaliato John P, McCormick Johnathon R, Nicholson Gregory P, Garrigues Grant E
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2025 Mar;34(3):e119-e125. doi: 10.1016/j.jse.2024.07.017. Epub 2024 Aug 30.
Although both anatomic (ATSA) and reverse total shoulder arthroplasty (rTSA) have been popularized as a means of treating individuals with degenerative shoulder conditions, the indications for each can vary widely among providers. Although surgeons with differing fellowship training commonly perform these procedures, it is not understood how fellowship training influences choice of implant.
A national database was queried to identify surgeons performing ATSA and rTSA. For all surgeons who performed more than 10 cases between 2010 and 2022, fellowship data were individually collected via an online search. For each fellowship group, rates of ATSA and rTSA were identified using International Classification of Diseases procedural codes. Those who underwent revision arthroplasty and those with a history of fracture, infection, or malignancy were excluded. Primary outcome measures included the proportion of primary and revision ATSAs and rTSAs by fellowship in addition to the rate of rTSA performed for a primary diagnosis of glenohumeral osteoarthritis.
A total of 131,974 patients met the inclusion criteria and were retained for this study. The proportion of rTSAs increased from 50.1% of all primary shoulder arthroplasty cases in 2011 to 72.0% in 2022. After adjusting for age and comorbidities, Sports Medicine fellowship-trained (Sports) surgeons opted for primary rTSA over ATSA at a significantly higher rate than Shoulder and Elbow fellowship-trained (Shoulder) surgeons and surgeons who completed another type of fellowship or no fellowship (Other). Sports surgeons also chose rTSA more frequently for the diagnosis of glenohumeral osteoarthritis than Shoulder surgeons. Surgeons in the Other cohort were more likely to perform primary ATSA rather than rTSA in comparison with surgeons in the Shoulder and Sports cohorts. Sports surgeons were responsible for the greatest increase in the percentage of all shoulder arthroplasty procedures from 2010 to 2022 (28.4%-40.4%), whereas the Other group decreased by a comparable amount (45.9%-32.4%) over the same period.
Surgeons who have completed a Sports Medicine fellowship choose rTSA over ATSA at a higher rate than Shoulder and Elbow surgeons, both for all indications and for a primary diagnosis of glenohumeral osteoarthritis. Those who have no fellowship training or fellowship training outside of Sports Medicine and Shoulder and Elbow surgery have the highest percentage of ATSAs in their arthroplasty practice. Revision ATSA and revision rTSA represent a larger percentage of overall case volume for Shoulder and Elbow surgeons.
尽管解剖型全肩关节置换术（ATSA）和反式全肩关节置换术（rTSA）都已作为治疗退行性肩部疾病患者的手段得到普及，但不同医疗服务提供者对每种手术的适应症选择差异很大。尽管接受不同专科培训的外科医生通常都会进行这些手术，但目前尚不清楚专科培训如何影响植入物的选择。
查询了一个全国性数据库，以确定实施ATSA和rTSA的外科医生。对于2010年至2022年间实施超过10例手术的所有外科医生，通过在线搜索单独收集其专科培训数据。对于每个专科培训组，使用国际疾病分类程序代码确定ATSA和rTSA的实施率。排除接受翻修关节成形术的患者以及有骨折、感染或恶性肿瘤病史的患者。主要观察指标包括按专科划分的初次和翻修ATSA及rTSA的比例，以及因原发性盂肱关节炎诊断而实施rTSA的比率。
共有131,974名患者符合纳入标准并被纳入本研究。rTSA在所有初次肩关节置换病例中的比例从2011年的50.1%增加到2022年的72.0%。在调整年龄和合并症后，接受运动医学专科培训（运动医学组）的外科医生选择初次rTSA而非ATSA的比率显著高于接受肩肘专科培训（肩肘组）的外科医生以及完成其他类型专科培训或未接受专科培训（其他组）的外科医生。与肩肘组外科医生相比，运动医学组外科医生在诊断盂肱关节炎时也更频繁地选择rTSA。与肩肘组和运动医学组外科医生相比，其他组外科医生更有可能实施初次ATSA而非rTSA。运动医学组外科医生负责的所有肩关节置换手术比例从2010年到2022年增长幅度最大（从28.4%增至40.4%），而同期其他组下降幅度相当（从45.9%降至32.4%）。
对于所有适应症以及原发性盂肱关节炎的诊断，完成运动医学专科培训的外科医生选择rTSA而非ATSA的比率高于肩肘外科医生。未接受专科培训或接受运动医学及肩肘外科以外专科培训的医生在其关节成形术实践中实施ATSA的比例最高。翻修ATSA和翻修rTSA在肩肘外科医生的总体病例量中占比更大。
