Barret Hugo, Tiercelin Joris, Godenèche Arnaud, Charousset Christophe, Audebert Stephane, Lefebvre Yves, Gallinet David, Barth Johannes, Bonnevialle Nicolas
Hôpital Pierre Paul Riquet - CHU de Toulouse, Toulouse, France.
Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Memoz, Lyon, France.
Bone Joint J. 2025 Feb 1;107-B(2):181-187. doi: 10.1302/0301-620X.107B2.BJJ-2024-1123.R1.
Loosening of the glenoid component in the long term remains an important complication of the anatomical total shoulder arthroplasty (aTSA). The aim of this study was to explore the bony integration of a hybrid glenoid component based on an analysis of CT scans.
In a prospective multicentre study, patients who underwent primary aTSA, whose hybrid design of glenoid component included a fully-polyethylene flanged upper peg and a porous-coated titanium lower peg, and who were reviewed with CT scans between 12 and 24 months postoperatively, were included. Two independent observers reviewed the scans. Bony integration of the upper peg was scored as described by Arnold et al, and integration of the lower peg was scored as described by Gulotta et al. Perforation of the glenoid vault in any plane was also assessed.
From an initial group of 120 aTSAs in 116 patients, 104 CT scans were analyzed in 100 patients (four bilateral shoulders, mean age 66 years (SD 11), 62 female and 38 male). Osteolysis around the upper peg was found in 32 patients (32 aTSAs; 31%). Of the remaining patients, 72 had a mean Arnold score of 5.6 points (SD 0.9), and 70 (67%) had perfect integration. The lower peg had a mean Gulotta score of 6.5 points (SD 1.4). There was perfect integration of the lower peg in 70 patients (70 aTSAs; 67%). A total of nine patients (nine aTSAs; 9%) had no bony integration at either peg. There was perforation of the glenoid in an anterior or posterior direction at the level of the upper peg in three and 28 patients, respectively. This occurred at the level of the lower peg in 11 and 18 patients, respectively. The inter- and intraobserver reliability was good (k = 0.782 and 0.86, respectively). No implant breakage occurred at a mean follow-up of 16 months (12 to 24). The clinical outcome was satisfactory at a mean follow-up of 32 months (24 to 35), as assessed by a visual analogue scale score for pain, the Constant-Murley score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons score.
Short-term CT scan analysis of a new hybrid anatomical glenoid component found perfect bony integration around the lower porous coated titanium peg in 90% of patients. The upper polyethylene flanged peg had bony integration in 70 patients (70 aTSAs; 67%). Longer follow-up is needed to analyze the rate of survival of this component. The short-term clinical outcome was satisfactory.
从长期来看，关节盂部件松动仍是解剖型全肩关节置换术（aTSA）的一项重要并发症。本研究旨在通过对CT扫描结果的分析，探讨混合型关节盂部件的骨整合情况。
在一项前瞻性多中心研究中，纳入接受初次aTSA手术的患者，其关节盂部件的混合设计包括一个全聚乙烯带凸缘的上固定桩和一个多孔涂层钛制下固定桩，且在术后12至24个月接受了CT扫描复查。两名独立观察者对扫描结果进行评估。上固定桩的骨整合情况按照阿诺德等人描述的方法进行评分，下固定桩的整合情况按照古洛塔等人描述的方法进行评分。同时还评估了关节盂穹窿在任何平面的穿孔情况。
最初的116例患者共120例aTSA手术，对其中100例患者（4例双侧肩关节，平均年龄66岁（标准差11），女性62例，男性38例）的104份CT扫描结果进行了分析。32例患者（32例aTSA手术；31%）在上固定桩周围发现骨溶解。在其余患者中，72例的阿诺德平均评分为5.6分（标准差0.9），70例（67%）实现了完美整合。下固定桩的古洛塔平均评分为6.5分（标准差1.4）。70例患者（70例aTSA手术；67%）的下固定桩实现了完美整合。共有9例患者（9例aTSA手术；9%）的两个固定桩均未实现骨整合。分别有3例和28例患者在上固定桩水平出现关节盂向前或向后的穿孔。分别有11例和18例患者在下固定桩水平出现这种情况。观察者间和观察者内的可靠性良好（分别为k = 0.782和0.86）。平均随访16个月（12至24个月）期间未发生植入物断裂。根据疼痛视觉模拟评分、Constant-Murley评分、主观肩关节评分和美国肩肘外科医生评分评估，平均随访32个月（24至35个月）时临床结果令人满意。
对一种新型混合解剖型关节盂部件进行的短期CT扫描分析发现，90%的患者在下多孔涂层钛制固定桩周围实现了完美的骨整合。70例患者（70例aTSA手术；67%）的上聚乙烯带凸缘固定桩实现了骨整合。需要更长时间的随访来分析该部件的生存率。短期临床结果令人满意。
