Charité University Hospital, Center for Musculoskeletal Surgery, Augustenburger Pl. 1, Berlin, 13353, Germany.
University Hospital Rechts der Isar, Technical University Munich, Munich, Germany.
BMC Musculoskelet Disord. 2024 Sep 20;25(1):752. doi: 10.1186/s12891-024-07870-8.
Insufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF.
In this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3-14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12).
At final follow-up, mean CS was 55 ± 19 (19-91), VAS averaged 3 ± 3 (0-8) and mean SSV was 61 ± 18% (18-90%). Mean SF-12 was 44 (28-57) with a mean physical component summary (PCS) of 38 (21-56) and a mean mental component summary (MCS) of 51 (29-67). On average active forward flexion (FF) was 104° (10-170°), active abduction (ABD) was 101° (50-170°), active external rotation (ER) was 19° (10-30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period.
Revision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome.
Retrospectively registered.
肱骨近端骨折（PHF）采用半髋关节置换术（HA）治疗后，愈合不足是导致预后不良的最常见原因。在这些情况下，翻修为反式全肩关节置换术（RTSA）可以在短期内改善功能并减轻疼痛，但长期结果仍然很少见。本研究的目的是评估在 PHF 失败后接受 RTSA 翻修的患者的中期至长期临床和影像学结果。
在这项回顾性研究中，我们纳入了数据库中所有在 2006 年至 2018 年间因 PHF 骨折 HA 失败而接受 RTSA 翻修的患者。共确定了 49 例（48 例患者，38 例女性，10 例男性；平均年龄 82±9 岁）和 40 例（38 例女性，2 例男性；平均年龄 79±9 岁）的患者在大约 8 年（3-14 年）的随访检查中可获得。在最终随访时，使用主观肩部值（SSV）、活动范围（ROM）、视觉模拟评分（VAS）、常数评分（CS）和 12 项简短形式调查（SF-12）评估患者。
在最终随访时，平均 CS 为 55±19（19-91），VAS 平均为 3±3（0-8），平均 SSV 为 61±18%（18-90%）。平均 SF-12 为 44（28-57），平均生理成分综合评分（PCS）为 38（21-56），平均心理成分综合评分（MCS）为 51（29-67）。平均主动前屈（FF）为 104°（10-170°），主动外展（ABD）为 101°（50-170°），主动外旋（ER）为 19°（10-30°），腰骶部可触及主动内旋（IR）。3 例患者在 RTSA 植入后出现假体周围肱骨干骨折，并在随访期间再次手术（15%）。
对于 PHF 初始 HA 失败后的患者，RTSA 翻修可获得有前景的临床结果。考虑到令人满意的功能和心理结果，15%的并发症和再手术率是可以接受的。
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