de Marinis Rodrigo, Sperling John W, Marigi Erick M, Velasquez Garcia Ausberto, Wagner Eric R, Sanchez-Sotelo Joaquin
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
JSES Rev Rep Tech. 2024 Aug 30;5(1):1-6. doi: 10.1016/j.xrrt.2024.08.006. eCollection 2025 Feb.
Revision reverse total shoulder arthroplasty (rTSA) of a previously cemented humeral component is challenging. In hip arthroplasty, the cement-within-cement (CwC) technique has been well described as an effective option. However, for shoulder arthroplasty there remains a paucity of data investigating this technique. The purpose of this study was to determine the mid-term outcomes of patients who underwent a revision rTSA utilizing the CwC for management of the humeral component.
Between 2005 and 2021, 68 revision rTSA using the CwC technique with a minimum of 2 years clinical follow-up were identified from a single institution joint registry database. Revised implants consisted of 38 (55.9%) hemiarthroplasties, 22 (32.4%) anatomic total shoulder arthroplasties, and 8 (11.8%) rTSA. A total of 12 (17.6%) shoulders required an osteotomy (corticotomy or window) to assist with extraction of the cemented stem. The mean follow-up after revision was 5.4 years (range, 2-16 years). Surgical complications, reoperations, revisions, and implant survivorship were assessed.
Of the 12 shoulders that required an osteotomy for component removal, 11 (91.7%) were healed. At final follow-up, the overall complication rate was 26.9%. The most common complication was fracture or fragmentation of the greater tuberosity (20.6%, n = 13) with 10 (76.9%) cases showing signs of healing at final follow-up. The overall survivorship free of revision surgery was 88.2% at 2 and 80.9% at 5 years, respectively. The most frequent causes of re-revision surgery were aseptic glenoid component loosening (n = 4) and instability (n = 4), with only 2 (2.9%) patients developing humeral component loosening (at 2 and 5 years, respectively). Male sex was associated with an increased risk of revision surgery (hazard ratio [HR], 3.52 [95% confidence interval [CI] 1.22-10.18]; = .02) and complications (HR, 3.56 [95% CI, 1.40-9.07]; = .008). The grade of postoperative lucent lines at the humerus (HR, 1.35 [95% CI, 1.04-1.74]; = .02) and glenoid (HR, 1.59 [95% CI, 1.22-2.10]; = .001) also correlated with an increased risk of re-revision surgery.
The CwC technique is a reliable option for revising previously cemented humeral components in revision rTSA. Although a low rate of humeral component loosening was observed, higher rates of complications and re-revision surgery were observed over time secondary to aseptic glenoid component loosening and instability, which are not directly related to CwC technique but to revision surgery in general.
对先前已使用骨水泥固定的肱骨组件进行翻修性反式全肩关节置换术（rTSA）具有挑战性。在髋关节置换术中，骨水泥内骨水泥（CwC）技术已被充分描述为一种有效的选择。然而，对于肩关节置换术，研究该技术的数据仍然很少。本研究的目的是确定采用CwC技术对肱骨组件进行翻修性rTSA的患者的中期疗效。
2005年至2021年间，从单一机构的关节登记数据库中确定了68例采用CwC技术进行翻修性rTSA且临床随访至少2年的病例。翻修植入物包括38例（55.9%）半关节成形术、22例（32.4%）解剖型全肩关节置换术和8例（11.8%）rTSA。共有12例（17.6%）肩关节需要进行截骨术（皮质切开术或开窗术）以辅助取出骨水泥固定柄。翻修后的平均随访时间为5.4年（范围为2至16年）。评估手术并发症、再次手术、翻修情况及植入物生存率。
在12例需要进行截骨术以取出组件的肩关节中，11例（91.7%）愈合。在最后随访时，总体并发症发生率为26.9%。最常见的并发症是大结节骨折或碎裂（20.6%，n = 13），其中10例（76.9%）在最后随访时显示有愈合迹象。无需翻修手术的总体生存率在2年时为88.2%，在5年时为80.9%。再次翻修手术最常见的原因是无菌性关节盂组件松动（n = 4）和不稳定（n = 4），只有2例（2.9%）患者出现肱骨组件松动（分别在2年和5年时）。男性进行翻修手术的风险增加（风险比[HR]，3.52[95%置信区间[CI]1.22 - 10.18]；P = 0.02），发生并发症的风险也增加（HR，3.56[95%CI，1.40 - 9.07]；P = 0.008）。肱骨（HR，1.35[95%CI，1.04 - 1.74]；P = 0.02）和关节盂（HR，1.59[95%CI，1.22 - 2.10]；P = 0.001）术后透亮线的分级也与再次翻修手术风险增加相关。
CwC技术是翻修先前已使用骨水泥固定的肱骨组件进行翻修性rTSA的可靠选择。尽管观察到肱骨组件松动率较低，但随着时间推移，由于无菌性关节盂组件松动和不稳定，并发症和再次翻修手术的发生率较高，这些与CwC技术无直接关系，而是与一般的翻修手术有关。
