Ranieri Riccardo, Borroni Mario, Delle Rose Giacomo, Conti Marco, Garofalo Raffaele, Castagna Alessandro
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Department of Orthopaedic and Traumatology Surgery, Shoulder and Elbow Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Bone Jt Open. 2025 Jan 14;6(1):82-92. doi: 10.1302/2633-1462.61.BJO-2024-0118.R1.
The aim of this study was to report long-term clinical outcomes of a modern convertible metal-backed glenoid (MBG) in total shoulder arthroplasty (TSA).
After a minimum of 15 years, a previously studied cohort of 35 patients who received a modern convertible MBG during the period 1996 to 2005 was contacted for clinical and radiological follow-up. At last follow-up, patients were evaluated radiologically and clinically according to the Constant Score, Simple Shoulder Test, and visual analogue scale for pain. Complications and revisions were recorded, and survival analysis was performed.
At the last follow-up, 20 patients were contacted. Of these, 15 patients had experienced at least one complication, and ten underwent revision surgery. The mean time to revision was 13.8 years (7 to 20). Cuff failure was the most common complication. Conversion to reverse shoulder arthroplasty, while maintaining the baseplate, was possible in five cases, with good results. In patients in whom the baseplate was removed, revision was performed significantly later (18.4 vs 11.1 years; p = 0.016). The general revision-free survival was 73% (95% CI 49.5 to 87.3) at 15 years and 38% (95% CI 11.8% to 64.3%) at 20 years, while MBG revision-free survival was 96.0% (95% CI 74.8% to 99.4%) at 15 years and 54% (95% CI 16.2% to 80.8%) at 20 years. Clinical scores showed a negative trend over time, although not statistically significant. Radiologically, polyethylene wear was observed in all cases and was complete in 12 out of 19 cases, and five glenoids were 'at risk' for loosening.
At long-term follow-up, convertible MBG-TSA revealed a high rate of complications and revision surgery, mainly due to soft-tissue failure and polyethylene wear occurring with time. Prompt conversion to RSA maintaining the baseplate provided good results and a low complication rate. Radiological follow-up at about ten years is strictly recommended and, if metal-to-metal contact is observed, conversion to RSA is advisable. These results emphasize the need for continued research into improving TSA outcomes, especially in cases of MBG usage.
本研究旨在报告现代可转换金属背衬肩胛盂（MBG）在全肩关节置换术（TSA）中的长期临床结果。
在至少15年后，联系了一组先前研究的35例患者，这些患者在1996年至2005年期间接受了现代可转换MBG，并进行了临床和放射学随访。在最后一次随访时，根据Constant评分、简单肩关节测试和疼痛视觉模拟量表对患者进行放射学和临床评估。记录并发症和翻修情况，并进行生存分析。
在最后一次随访时，联系到了20例患者。其中，15例患者至少经历了一种并发症，10例接受了翻修手术。翻修的平均时间为13.8年（7至20年）。肩袖失效是最常见的并发症。在5例患者中，在保留基板的情况下转换为反向肩关节置换术，效果良好。在移除基板的患者中，翻修时间明显更晚（18.4年对11.1年；p = 0.016）。总体无翻修生存率在15年时为73%（95%CI 49.5至87.3），在20年时为38%（95%CI 11.8%至64.3%），而MBG无翻修生存率在15年时为96.0%（95%CI 74.8%至99.4%），在20年时为54%（95%CI 16.2%至80.8%）。临床评分随时间呈下降趋势，尽管无统计学意义。放射学检查发现，所有病例均有聚乙烯磨损，19例中有12例磨损完全，5个肩胛盂有松动“风险”。
在长期随访中，可转换MBG-TSA显示出较高的并发症和翻修手术率，主要是由于软组织失效和随时间出现的聚乙烯磨损。及时转换为保留基板的RSA可取得良好效果且并发症发生率低。强烈建议在大约十年时进行放射学随访，如果观察到金属对金属接触，建议转换为RSA。这些结果强调了继续研究改善TSA结果的必要性，特别是在使用MBG的情况下。
