Kriechling Philipp, Neopoulos Georgios, Berger Alexander, Stein Philipp, Götschi Tobias, Grubhofer Florian, Wieser Karl
Balgrist University Hospital, Orthopaedic Department, University of Zurich, Zurich, Switzerland.
JSES Int. 2024 Nov 9;9(2):445-452. doi: 10.1016/j.jseint.2024.10.002. eCollection 2025 Mar.
Movement limitations following implantation of reverse total shoulder arthroplasty (rTSA) have been observed in some patients postoperatively, with implant design and positioning recognized as important influential factors. Recent analyses have identified patient's posture, measured as scapula internal rotation on computed tomography (CT), as an additional factor influencing the functional outcome after rTSA. However, no clinical study has correlated the preoperatively photo-documented posture to functional outcome. It was the aim of this study to correlate preoperatively photo-documented posture to scapula orientation using CT and analyze the influence on functional outcome following rTSA implantation.
A prospectively enrolled rTSA database was retrospectively reviewed to include a total of 360 patients with a minimum follow-up of 2 years. Patient's posture was analyzed using standardized preoperative photo and video documentation. The posture was defined following the classification system of Moroder et al as type A (upright posture, retracted scapulae), type B (intermediate), and type C (kyphotic posture with protracted scapulae). In addition, CT data were used to measure scapula position (internal rotation). Correlation analyses between them were conducted. Postoperative range of motion (ROM) and clinical outcomes (absolute Constant-Murley Score and relative Constant-Murley Score) were compared between the different posture types.
According to the photo-documented posture types, the patients were divided into posture types A (n = 59), B (n = 253) and C (n = 48). Average absolute Constant-Murley Score differed significantly among the groups (69 ± 16 vs. 69 ± 14 vs. 64 ± 16, < .05) favoring patients with posture types A and B over type C. In terms of ROM, flexion, abduction, and internal rotation significantly differed among the groups. Types A and B exhibited better flexion and abduction (flexion 124 ± 26° and 123 ± 23° vs. 113 ± 25°, abduction 140 ± 34° and 137 ± 30° vs. 128 ± 34°). Patients with posture type A demonstrated superior internal rotation (CS points: 5.9 ± 2.9 vs. 5.0 ± 2.7 vs. 4.4 ± 2.8, < .05). External rotation was better for type A compared to type C (A: 33 ± 17° vs. B: 30 ± 16° vs. C: 28 ± 18°). Correlation analysis of posture classification using photo documentation and CT scan showed poor reliability (r = 0.35).
Patients with clinical posture types A and B exhibited improved ROM values compared to type C postures. Clinical outcome scores were also notably superior in types A and B. However, the measurement of scapula internal rotation on supine CT does not reliably correlate with photo documentation of patient's posture. Preoperatively, patient's posture should be considered in rTSA planning because of the potential influence on ROM and clinical outcomes.
部分患者在接受反式全肩关节置换术（rTSA）后出现活动受限，植入物设计和位置被认为是重要的影响因素。最近的分析表明，患者的姿势（通过计算机断层扫描（CT）测量肩胛内旋）是影响rTSA术后功能结果的另一个因素。然而，尚无临床研究将术前照片记录的姿势与功能结果相关联。本研究的目的是将术前照片记录的姿势与使用CT测量的肩胛方向相关联，并分析rTSA植入后对功能结果的影响。
回顾性分析前瞻性纳入的rTSA数据库，共纳入360例患者，最小随访时间为2年。使用标准化的术前照片和视频记录分析患者的姿势。姿势按照Moroder等人的分类系统定义为A 型（直立姿势，肩胛后缩）、B型（中间型）和C型（驼背姿势，肩胛前伸）。此外，使用CT数据测量肩胛位置（内旋）。对两者进行相关性分析。比较不同姿势类型之间的术后活动范围（ROM）和临床结果（绝对Constant-Murley评分和相对Constant-Murley评分）。
根据照片记录的姿势类型，患者分为A 型（n = 59）、B型（n = 253）和C型（n = 48）。各组间平均绝对Constant-Murley评分差异显著（69±16 vs. 69±14 vs. 64±16，P <.05），A 型和B型患者优于C型。在ROM方面，各组间的屈曲、外展和内旋差异显著。A 型和B型的屈曲和外展更好（屈曲124±26°和12
