Jenkins Sarah M, Elwell Josie, Muh Stephanie J, Roche Christopher P, Rogalski Brandon L, Eichinger Josef K, Friedman Richard J
Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA.
Exactech, Inc., Gainesville, FL, USA.
J Shoulder Elbow Surg. 2025 Jun;34(6):1471-1476. doi: 10.1016/j.jse.2024.08.047. Epub 2024 Nov 5.
BACKGROUND/HYPOTHESIS: Reverse total shoulder arthroplasty (rTSA) has become the operative treatment of choice for acute proximal humerus fractures in the elderly population, but little data exist on the long-term outcomes or how they compare to rTSA done for degenerative conditions. The purpose of this study is to compare the clinical and radiographic outcomes of patients undergoing rTSA for acute fracture versus degenerative conditions with a minimum 5-year follow-up.
Data was extracted from an international registry of patients with the Exactech Equinoxe rTSA implant from 2007 to 2018. Patients with a minimum follow-up of 5 years were then split into fracture and degenerative cohorts and matched 1:3 based on age, sex, and follow-up duration. Clinical and radiographic outcomes were compared between the cohorts including range of motion, patient-reported outcome measures, visual analouge scale pain score, complication and revision rates, implant characteristics, and scapular notching. This data was analyzed using Welch's t-test, Fisher's exact test, or Wilcoxon rank sum test.
There were 384 total patients included in the study, with 96 fractures and 288 degenerative. At a mean follow-up of 6.4 years, the degenerative cohort had significant improvements in all patient-reported outcome measures and range of motion, compared to their preoperative status. At the latest follow-up, the mean American Shoulder and Elbow Surgeons score was 83 and the mean visual analouge scale pain score was 1.1 for both cohorts. Patients with degenerative indications had greater forward elevation which did not meet the minimally clinically important difference and greater internal rotation which did not meet the substantial clinical benefit threshold. Patient satisfaction was very high for both cohorts, with 97% in the degenerative cohort and 91% in the fracture cohort satisfied with the procedure (P = .276). Complication and revision rates were similar between the 2 cohorts. Patients in the fracture cohort had a larger glenosphere diameter (P = .045) and greater combined liner/tray offset (P = .05). Patients in the elective cohort more frequently required an augmented baseplate (P < .001). Scapular notching was 11% in the degenerative cohort and 9% in the fracture cohort (P = .82).
This study demonstrates no significant differences in the clinical or radiographic outcomes at a minimum of 5 years follow-up for patients undergoing rTSA for acute fracture versus degenerative conditions. Patients undergoing rTSA for either indication have similar rates of complications, revisions, and scapular notching, with high patient satisfaction. Patients undergoing rTSA for an acute fracture can expect similar results to those undergoing rTSA for degenerative conditions at minimum 5-year follow-up.
背景/假设：反向全肩关节置换术（rTSA）已成为老年人群急性肱骨近端骨折的手术治疗选择，但关于其长期疗效以及与用于退行性疾病的rTSA相比的数据较少。本研究的目的是比较接受rTSA治疗急性骨折与退行性疾病且随访至少5年的患者的临床和影像学结果。
从2007年至2018年使用Exactech Equinoxe rTSA植入物的患者国际登记处提取数据。然后将随访至少5年的患者分为骨折组和退行性疾病组，并根据年龄、性别和随访时间按1:3进行匹配。比较两组之间的临床和影像学结果，包括活动范围、患者报告的结局指标、视觉模拟量表疼痛评分、并发症和翻修率、植入物特征以及肩胛切迹。使用Welch t检验、Fisher精确检验或Wilcoxon秩和检验对该数据进行分析。
该研究共纳入384例患者，其中骨折患者96例，退行性疾病患者288例。平均随访6.4年时，与术前状态相比，退行性疾病组在所有患者报告的结局指标和活动范围方面均有显著改善。在最近一次随访时，两组的美国肩肘外科医师协会平均评分为83分，视觉模拟量表平均疼痛评分为1.1分。患有退行性疾病指征的患者前屈抬高幅度更大，但未达到最小临床重要差异，内旋幅度更大，但未达到实质性临床获益阈值。两组患者的满意度都很高，退行性疾病组为97%，骨折组为91%对手术满意（P = 0.276）。两组之间的并发症和翻修率相似。骨折组患者的球盂假体直径更大（P = 0.045），衬垫/托盘联合偏移更大（P = 0.05）。择期手术组患者更频繁地需要使用增强型基板（P < 0.001）。退行性疾病组肩胛切迹发生率为11%，骨折组为9%（P = 0.82）。
本研究表明，接受rTSA治疗急性骨折与退行性疾病且随访至少5年的患者，其临床或影像学结果无显著差异。因任何一种指征接受rTSA治疗的患者并发症、翻修和肩胛切迹发生率相似，患者满意度高。接受rTSA治疗急性骨折的患者在至少5年随访时可预期与接受rTSA治疗退行性疾病的患者有相似的结果。
