S O'Keefe Daniel, Teurlings Tyler L, Hao Kevin A, Saengchote Supreeya A, Schoch Bradley S, Wright Thomas W, Farmer Kevin W, Struk Aimee M, King Joseph J
College of Medicine, University of Florida, Gainesville, FL, USA.
Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
Shoulder Elbow. 2024 Oct;16(5):543-550. doi: 10.1177/17585732231202214. Epub 2023 Sep 18.
The increasing incidence of reverse total shoulder arthroplasties (RTSA) has led to an increase in revision surgery. We aimed to compare patients undergoing re-revision RTSA to a matched cohort undergoing first-revision RTSA.
A retrospective review of all revision RTSAs was performed at a single institution. Sixteen shoulders that underwent re-revision RTSA were matched 1:3 to shoulders that underwent revision RTSA with a minimum two-year follow-up. Outcome scores including the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Short-Form 12 (SF-12), Shoulder Pain and Disability Index (SPADI), and Simple Shoulder Test (SST) scores, range of motion (ROM), and improvement from preoperative to postoperative outcomes after re-revision RTSA were assessed. Additionally, postoperative outcomes after re-revision RTSA were compared to patients that underwent first revision RTSA and subsequently compared to the minimal clinically important difference (MCID) values for the outcome scores and ROM measurements assessed.
Sixteen shoulders that underwent re-revision RTSA and 78 revision RTSAs met the final inclusion criteria to be included in this study. Significant improvement from preoperative to postoperative re-revision RTSA was seen in the ASES score (p = 0.046), SPADI score (p = 0.044), SST (p = 0.008), abduction (p = 0.016), and elevation (p = 0.025), but not the SF-12 score (p = 0.396), external rotation (p = 0.449), or internal rotation (p = 0.451). Outcomes after revision RTSA were found to be superior to outcomes after re-revision RTSA for all outcome scores (ASES p = 0.029, SF-12 p = 0.018, SPADI p = 0.003) except the SST score (p = 0.080) and all ROM measures (p > 0.05 for all). Internal rotation was equivalent postoperatively between both groups. From preoperative to postoperative re-revision RTSA, the mean improvement exceeded the MCID for the SST score, abduction, forward elevation, and external rotation. When comparing postoperative revision RTSA to postoperative re-revision RTSA, the mean difference between revision and re-revision RTSA exceeded the MCID for the SPADI score and external rotation. The complication rate was 19% in shoulders undergoing first revision and 41% in shoulders undergoing re-revision RTSA.
Patients undergoing re-revision RTSA receive improvement in clinical outcomes, but do not achieve outcomes comparable to those achieved after first revision RTSA.
反向全肩关节置换术（RTSA）的发病率不断上升，导致翻修手术增加。我们旨在比较接受再次翻修RTSA的患者与接受初次翻修RTSA的匹配队列。
在单一机构对所有翻修RTSA进行回顾性研究。16例接受再次翻修RTSA的肩关节与接受翻修RTSA且至少随访两年的肩关节按1:3匹配。评估包括美国肩肘外科医师协会肩部评分（ASES）、简明健康调查问卷12项（SF-12）、肩痛和功能障碍指数（SPADI）以及简易肩部测试（SST）评分、活动范围（ROM），以及再次翻修RTSA术后从术前到术后的改善情况。此外，将再次翻修RTSA术后的结果与接受初次翻修RTSA的患者进行比较，随后与所评估的结果评分和ROM测量的最小临床重要差异（MCID）值进行比较。
16例接受再次翻修RTSA的肩关节和78例翻修RTSA符合本研究的最终纳入标准。再次翻修RTSA术后，ASES评分（p = 0.046）、SPADI评分（p = 0.044）、SST（p = 0.008）、外展（p = 0.016）和上举（p = 0.025）从术前到术后有显著改善，但SF-12评分（p = 0.396）、外旋（p = 0.449）或内旋（p = 0.451）无显著改善。对于所有结果评分（ASES p = 0.029，SF-12 p = 0.018，SPADI p = 0.003），翻修RTSA术后的结果优于再次翻修RTSA术后的结果，但SST评分（p = 0.080）和所有ROM测量值（所有p > 0.05）除外。两组术后内旋情况相当。再次翻修RTSA术后，从术前到术后，SST评分、外展、前屈上举和外旋的平均改善超过了MCID。将翻修RTSA术后与再次翻修RTSA术后进行比较时，翻修和再次翻修RTSA之间的平均差异超过了SPADI评分和外旋的MCID。初次翻修肩关节的并发症发生率为19%，再次翻修RTSA肩关节的并发症发生率为41%。
接受再次翻修RTSA的患者临床结果有所改善，但未达到初次翻修RTSA术后的结果。
