Simcox Trevor G, Hao Kevin A, Dada Oluwaferanmi, Beason Austin M, Khlopas Anton, Farmer Kevin W, King Joseph J, Schoch Bradley S, Wright Thomas W, Struk Aimee M, Wright Jonathan O
Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
College of Medicine, University of Florida, Gainesville, FL, USA.
J Shoulder Elbow Surg. 2025 Apr;34(4):1071-1080. doi: 10.1016/j.jse.2024.07.036. Epub 2024 Sep 11.
Stilting is a novel technique used in reverse shoulder arthroplasty (RSA) in patients with significant glenoid bone loss. This technique utilizes peripheral locking screws placed behind an unseated portion of the baseplate to transmit forces from the baseplate to the cortical surface of the glenoid, without the need for bone grafting. The stilted screw, once locked, provides a fixed angle point of support for this unseated aspect of a baseplate. The primary advantages of this technique are reduced cost compared to a custom implant and reduced operative time compared to bone grafting.
We conducted a retrospective, nonrandomized, comparative cohort study of 41 patients who underwent primary RSA using the stilting technique with the Exactech Equinoxe Reverse System (Gainesville, FL, USA) at a single academic center from the years 2004 to 2021. Exclusion criteria included age under 18 or over 100 and oncologic or acute fracture RSA indications. Operative data was documented, including implant records, percent baseplate seating, and operative duration. Survivorship was compared among primary stilted RSA (n = 41), bone grafted RSA (n = 42), and non-stilted/non-bone grafted RSA (n = 1032) within our institutional shoulder arthroplasty database. A radiographic examination of baseplate failure was also conducted across the study groups. Postoperative functional outcomes were compared in a matched analysis involving patients with a minimum 2-year follow-up between stilted patients and a non-stilted/non-bone grafted control group for primary RSA.
All stilted RSA cases utilized metal augments and demonstrated a mean baseplate seating of 61% (range 45%-75%). For stilted RSAs, survivorship was 100% and 92.6% at 2 years and 5 years, compared to 98.3% and 94.6% for non-stilted/non-bone grafted and 96.3% and 79.5% for bone grafted RSAs (P = .042). At 5 years, the baseplate-related failure rates were greater in the stilted (7.4%) and the bone-grafted (9.3%) cohorts compared with the non-stilted/non-bone grafted cohort (1.1%, P < .001). The mean time to baseplate failure was 30 months for stilted RSA. Functional outcomes for primary RSA were statistically similar between stilted and non-stilted patients, including range of motion, Constant, American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California, Los Angeles, and Shoulder Pain and Disability Index scores.
The stilted RSA cohort exhibited noninferior revision and baseplate failure rates to that of bone grafted RSA. This suggests that stilting may be a viable technique for patients undergoing primary RSA with significant glenoid deformity.
高跷技术是一种用于严重关节盂骨缺损患者的反肩置换术（RSA）的新技术。该技术利用置于基板未就位部分后方的周边锁定螺钉，将力量从基板传递至关节盂的皮质表面，无需植骨。高跷螺钉一旦锁定，便为基板的该未就位部分提供一个固定角度的支撑点。与定制植入物相比，该技术的主要优势在于成本降低，与植骨相比，手术时间缩短。
我们对2004年至2021年在单一学术中心使用Exactech Equinoxe反肩系统（美国佛罗里达州盖恩斯维尔）的高跷技术进行初次RSA的41例患者进行了一项回顾性、非随机、对比队列研究。排除标准包括年龄低于18岁或超过100岁以及肿瘤或急性骨折RSA适应症。记录手术数据，包括植入物记录、基板就位百分比和手术持续时间。在我们机构的肩关节置换数据库中，比较初次高跷RSA（n = 41）、植骨RSA（n = 42）和非高跷/非植骨RSA（n = 1032）的生存率。还对各研究组进行了基板失败的影像学检查。在一项匹配分析中，比较了初次RSA的高跷患者与非高跷/非植骨对照组中至少随访2年的患者的术后功能结果。
所有高跷RSA病例均使用金属增强物，平均基板就位率为61%（范围45%-75%）。对于高跷RSA，2年和5年的生存率分别为100%和92.6%，相比之下，非高跷/非植骨RSA分别为98.3%和94.6%，植骨RSA分别为96.3%和79.5%（P = 0.042）。在5年时，与非高跷/非植骨队列（1.1%，P < 0.001）相比，高跷（7.4%）和植骨（9.3%）队列的基板相关失败率更高。高跷RSA的基板失败平均时间为30个月。初次RSA的功能结果在高跷患者和非高跷患者之间在统计学上相似，包括活动范围、Constant评分、美国肩肘外科医师学会评分、简单肩部测试、加利福尼亚大学洛杉矶分校评分以及肩部疼痛和残疾指数评分。
高跷RSA队列在翻修和基板失败率方面不劣于植骨RSA。这表明对于患有严重关节盂畸形的初次RSA患者，高跷技术可能是一种可行的技术。
