Shoulder Centre, Sports Traumatology Prof. Habermeyer, Törringstrasse 6, 81675, Munich, Germany.
OCM (Orthopädische Chirurgie München) Clinic, München, Germany.
Arch Orthop Trauma Surg. 2024 Sep;144(9):4365-4374. doi: 10.1007/s00402-024-05536-7. Epub 2024 Oct 3.
The older generation of high thickness metal-backed glenoid prostheses had a high failure rate. The goal of our study was to analyze the medium-term clinical and radiological results of a technically modified generation of metal backed glenoids with 35% decrease in thickness.
Thirty-nine patients (43 shoulders) with a mean age of 66.5 years at surgery were examined from two to ten years (mean 71.2 months) using the Constant-Score, Subjective Shoulder Value and X-ray in a.p. and axial view. Indication for surgery included patients with glenoid types B1, B2, or B3 and/or posterior subluxation but intact rotator cuff, or patients who did not want a reverse prosthesis and had high functional demands. Inclusion criteria comprised participation in a clinical and radiological follow-up examination, along with a minimum follow-up duration of 24 months. Additionally, in all cases, the Constant Score and the Subjective Shoulder Value (PROM) had to be determined. Exclusion criteria were an incomplete dataset, implantation of a different prosthesis type, and failure to meet the minimum follow-up time.
The absolute Constant Score (CS) improved significantly (p < 0.0001) from 43 ± 13 (range: 20-69) points before to 80 ± 13 (range: 46-98) points after surgery. The only preoperative negative influencing factor on the result was the glenoid protrusion according to Lévigne (p = 0.0150). No significant differences in functional outcomes were found between glenoid types A2, B1, B2 and B3. Radiolucent lines at the interface were observed in a total of four patients (13%). Radiological signs of glenoid osteolysis were seen in six patients (20%). Humeral upward migration was observed in four patients (13%) and posterior shoulder joint decentering occurred in one patient (3%). Implant-specific complications occurred in three cases (7%). Due to a massive rotator cuff tear, two cases (4.7%) had to be converted to a reversed implant, with the primary metal component remaining in place. If the implant-specific and rotator cuff-associated complications are summarized, the rate is 11.7%. All components that required conversion to an reverse implant have so far remained free of complications.
Favorable clinical results can be achieved, especially in patients with an eccentric glenoid type. Severe preoperative glenoid erosion (Walch A2, B2, B3) does not appear to have any influence on postoperative functional results. The complication and revision rates are significantly better than in previous studies with conventional metal-backed glenoid components. Conversion of the anatomical glenoid component to a reverse system was always possible and good clinical results were achieved.
上一代高厚度金属背衬肩胛盂假体的失败率很高。我们的研究目的是分析技术改良的金属背衬肩胛盂假体的中期临床和影像学结果，其厚度减少了 35%。
对 39 名（43 肩）平均年龄为 66.5 岁的患者进行了手术，随访时间为 2 至 10 年（平均 71.2 个月），采用 Constant-Score、主观肩部评分和前后位及轴向 X 线进行评估。手术指征包括肩胛盂类型 B1、B2 或 B3 以及/或后脱位但肩袖完整，或不想使用反向假体且功能要求较高的患者。纳入标准包括参加临床和影像学随访检查，且随访时间至少 24 个月。此外，在所有病例中，均需确定 Constant 评分和主观肩部评分（PROM）。排除标准为数据集不完整、植入不同类型的假体以及未达到最低随访时间。
术前绝对 Constant 评分（CS）为 43±13（范围：20-69）分，术后为 80±13（范围：46-98）分，显著改善（p<0.0001）。唯一术前对结果有负面影响的因素是根据 Lévigne 的肩胛盂突出（p=0.0150）。肩胛盂类型 A2、B1、B2 和 B3 之间的功能结果无显著差异。共有 4 名患者（13%）出现界面处透亮线。6 名患者（20%）出现肩胛盂溶骨性放射学征象。4 名患者（13%）出现肱骨向上迁移，1 名患者（3%）出现肩关节后偏心。3 例（7%）发生假体特异性并发症。由于巨大肩袖撕裂，2 例（4.7%）需要转换为反向植入物，主要金属部件仍保留在位。如果将假体特异性和肩袖相关并发症进行总结，发生率为 11.7%。所有需要转换为反向植入物的组件目前均无并发症。
可获得良好的临床效果，特别是在偏心肩胛盂类型的患者中。严重的术前肩胛盂侵蚀（Walch A2、B2、B3）似乎对术后功能结果没有影响。并发症和翻修率明显优于以往使用传统金属背衬肩胛盂假体的研究。解剖肩胛盂组件转换为反向系统始终是可行的，且可获得良好的临床效果。
