Smeitink Nick, Schröder Femke F, Dorrestijn Oscar, Spekenbrink-Spooren Anneke, Govaert Louise H M, Veen Egbert J D
Department of Orthopaedics, Medical Spectrum Twente, Enschede, Netherlands.
Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
Bone Joint J. 2025 Jan 1;107-B(1):97-102. doi: 10.1302/0301-620X.107B1.BJJ-2024-0459.R1.
Hemiarthroplasty (HA) and total shoulder arthroplasty (TSA) are often the preferred forms of treatment for patients with atraumatic avascular necrosis of the humeral head when conservative treatment fails. Little has been reported about the survival of HA and TSA for this indication. The aim of this study was to investigate the differences in revision rates between HA and TSA in these patients, to determine whether one of these implants has a superior survival and may be a better choice in the treatment of this condition.
Data from 280 shoulders with 159 primary HAs and 121 TSAs, which were undertaken in patients with atraumatic avascular necrosis of the humeral head between January 2014 and January 2023 from the Dutch Arthroplasty Register (LROI), were included. Kaplan-Meier survival analysis and Cox regression analysis were undertaken.
Within four years of follow-up, a total of 15 revisions were required, involving seven HAs (4%) and eight TSAs (7%). This difference was not statistically significant (p = 0.523). Two HAs were revised because of progressive glenoid erosion, and three TSAs were revised for loosening of the glenoid component. The cumulative percentages of revision of HA and TSA were 6% and 8%, respectively (HR 1.1 (95% CI 0.5 to 2.7)).
We found no significant difference in short- to mid-term implant survival between the use of a HA and a TSA in the treatment of atraumatic avascular necrosis of the humeral head, without significant glenoid wear.
当保守治疗失败时，半肩关节置换术（HA）和全肩关节置换术（TSA）通常是肱骨头非创伤性缺血性坏死患者的首选治疗方式。关于HA和TSA用于该适应症的生存率报道较少。本研究的目的是调查这些患者中HA和TSA翻修率的差异，以确定这些植入物中的一种是否具有更高的生存率，并且在治疗这种疾病时可能是更好的选择。
纳入了2014年1月至2023年1月期间在荷兰关节置换登记处（LROI）对肱骨头非创伤性缺血性坏死患者进行的280例肩部手术数据，其中包括159例初次HA和121例TSA。进行了Kaplan-Meier生存分析和Cox回归分析。
在四年的随访期内，总共需要进行15次翻修，其中包括7例HA（4%）和8例TSA（7%）。这种差异无统计学意义（p = 0.523）。2例HA因进行性关节盂侵蚀而翻修，3例TSA因关节盂组件松动而翻修。HA和TSA的累积翻修百分比分别为6%和8%（风险比1.1（95%置信区间0.5至2.7））。
我们发现，在治疗无明显关节盂磨损的肱骨头非创伤性缺血性坏死时，使用HA和TSA在短期至中期植入物生存率方面没有显著差异。
