Hao Kevin A, Elwell Josie, Traverse Jennifer M, Simovitch Ryan W, Wright Thomas W, King Joseph J, Schoch Bradley S
Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA.
Exactech, Inc., Gainesville, FL, USA.
J Shoulder Elbow Surg. 2025 Jun;34(6):1514-1524. doi: 10.1016/j.jse.2024.09.035. Epub 2024 Nov 23.
Pain relief plays a major deterministic role when assessing postoperative patient satisfaction; however, whether anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) provides the most durable pain relief has not been studied. The purpose of this study was to evaluate the durability of pain relief after aTSA compared with rTSA in patients undergoing surgery for rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA).
A retrospective review of a multicenter shoulder arthroplasty database (Exactech Equinoxe) was performed. We included 1848 aTSAs and 1464 rTSAs performed for RCI-GHOA between 2007 and 2023. Pain after surgery was assessed postoperatively at 3 months, 6 months, and yearly thereafter. Average postoperative pain on a daily basis and pain at worst were compared between aTSA and rTSA up to 8 years postoperatively. Kaplan-Meier survivorship analysis for pain relief maintenance was performed to compare the maintenance of clinically relevant pain relief defined as pain scores that achieved the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS). Maintenance of favorable patient satisfaction over time was also evaluated. Multivariable cox regression was performed to determine whether the type of prosthesis (aTSA vs. rTSA) was independently associated with pain recurrence.
Maintenance of achievement of the MCID and SCB for both daily pain and pain at worst as well as favorable patient satisfaction was similar between aTSAs and rTSAs. However, aTSA had longer maintenance of average daily pain below the PASS compared with rTSA (P = .024). This was confirmed on multivariable cox regression analysis, which found that rTSAs had a 34% greater likelihood of recurrence of postoperative average daily pain exceeding the PASS (visual analog scale score rating 1/10) compared with aTSAs.
Patients who undergo either aTSA or rTSA for RCI-GHOA and achieve initial pain relief postoperatively can expect to maintain their clinically relevant pain improvement at similar rates up to 8 years postoperatively. However, recurrence of low levels of daily pain was significantly higher after rTSA.
在评估术后患者满意度时，疼痛缓解起着主要的决定性作用；然而，解剖型全肩关节置换术（aTSA）或反式全肩关节置换术（rTSA）是否能提供最持久的疼痛缓解尚未得到研究。本研究的目的是评估在接受肩袖完整的盂肱关节骨关节炎（RCI-GHOA）手术的患者中，aTSA与rTSA术后疼痛缓解的持久性。
对一个多中心肩关节置换数据库（Exactech Equinoxe）进行回顾性分析。我们纳入了2007年至2023年间因RCI-GHOA进行的1848例aTSA和1464例rTSA。术后疼痛在术后3个月、6个月及之后每年进行评估。比较aTSA和rTSA术后长达8年的每日平均术后疼痛和最严重疼痛。进行Kaplan-Meier生存分析以比较达到最小临床重要差异（MCID）、显著临床获益（SCB）和患者可接受症状状态（PASS）的临床相关疼痛缓解的维持情况。还评估了患者满意度随时间的良好维持情况。进行多变量cox回归以确定假体类型（aTSA与rTSA）是否与疼痛复发独立相关。
aTSA和rTSA在每日疼痛和最严重疼痛达到MCID和SCB以及良好患者满意度的维持方面相似。然而，与rTSA相比，aTSA在PASS以下的平均每日疼痛维持时间更长（P = 0.024）。多变量cox回归分析证实了这一点，该分析发现与aTSA相比，rTSA术后平均每日疼痛超过PASS（视觉模拟量表评分为1/10）复发的可能性高34%。
因RCI-GHOA接受aTSA或rTSA且术后最初疼痛得到缓解的患者，预计在术后长达8年的时间里，其临床相关疼痛改善能以相似的速率维持。然而，rTSA后每日低水平疼痛的复发明显更高。
