Bents Easton J, Ardebol Javier, Noble Mathew, Galasso Lisa, Denard Patrick J, Menendez Mariano E
ATSU-SOMA, Mesa, AZ, USA.
Oregon Shoulder Institute, Medford, OR, USA.
JSES Rev Rep Tech. 2024 Aug 29;5(1):60-69. doi: 10.1016/j.xrrt.2024.08.007. eCollection 2025 Feb.
Reverse total shoulder arthroplasty (rTSA) is an increasingly common procedure for proximal humerus fractures (PHFs), but postoperative complications have not been well characterized. The purpose of this systematic review is to assess complications and revision rates following rTSA in the management of PHFs as documented in current literature.
A systematic review was performed on primary rTSA for PHFs. In adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted between September and December of 2023, utilizing the databases PubMed, Scopus, and the Cochrane Library to include relevant articles from any period. A total of 102 studies were identified for inclusion after initial screening of 3800 query results. Extracted data from each article included the publishing journal, level of evidence, study design, number of patients, mean age, age range, percent female, mean follow-up, specific postoperative complications, total complications, complication rate, number of revisions, and revision rate. Overall complication rates were determined by dividing total complications by total patients and multiplying by 100, which also applied to revision rates.
Among 10,797 primary rTSA cases for PHFs identified from 102 studies, the mean age of patients was 75.6 ± 3.6 years, and 82.6% of patients were female. The average follow-up was 38.9 ± 21.0 months. The overall complication rate was 7.0% (754/10,797) with a range of 0% to 46.9%. The most common postoperative complications were prosthetic instability/dislocation (2.3%, 244/10,797; range: 0%-7%) and infection (1.2%, 131/10,797; range: 0%-2.5%). Periprosthetic fracture (0.8%), nerve injury (0.3%), and other complications were also documented. The overall revision rate was 3.3% (355/10,797; range: 0%-28%).
This systematic review summarizes the most common postoperative complications of rTSA for PHFs. The most frequent complication was prosthetic instability/dislocation, followed by infection. While the average total complication and revision rates were relatively low, there was wide variability, with some studies reporting rates as high as 46% and 28%, respectively.
反式全肩关节置换术（rTSA）是治疗肱骨近端骨折（PHF）越来越常用的手术方法，但术后并发症尚未得到充分描述。本系统评价的目的是评估当前文献中记录的rTSA治疗PHF后的并发症和翻修率。
对治疗PHF的初次rTSA进行系统评价。按照系统评价和Meta分析的首选报告项目指南，于2023年9月至12月进行系统检索，利用PubMed、Scopus和Cochrane图书馆数据库纳入任何时期的相关文章。在对3800条检索结果进行初步筛选后，共确定102项研究纳入。从每篇文章中提取的数据包括发表期刊、证据水平、研究设计、患者数量、平均年龄、年龄范围、女性百分比、平均随访时间、特定术后并发症、总并发症、并发症发生率、翻修数量和翻修率。总体并发症发生率通过将总并发症数除以总患者数再乘以100来确定，翻修率计算方法相同。
从102项研究中确定的10797例治疗PHF的初次rTSA病例中，患者的平均年龄为75.6±3.6岁，82.6%为女性。平均随访时间为38.9±21.0个月。总体并发症发生率为7.0%（754/10797），范围为0%至46.9%。最常见的术后并发症是假体不稳定/脱位（2.3%，244/10797；范围：0% - 7%）和感染（1.2%，131/10797；范围：0% - 2.5%）。还记录了假体周围骨折（0.8%）、神经损伤（0.3%）和其他并发症。总体翻修率为3.3%（355/10797；范围：0% - 28%）。
本系统评价总结了rTSA治疗PHF最常见的术后并发症。最常见的并发症是假体不稳定/脱位，其次是感染。虽然总体并发症和翻修率相对较低，但存在很大差异，一些研究报告的发生率分别高达46%和28%。
