Hawayek Bradley, Martin Sean, McGuire Matthew, Caiola Marco, Haider M Nadir, Feng Lin, Duquin Thomas R
Department of Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, NY, USA.
JSES Rev Rep Tech. 2025 Jan 31;5(2):131-139. doi: 10.1016/j.xrrt.2025.01.001. eCollection 2025 May.
Patients with glenohumeral arthritis with Walch B2 glenoid morphology present a challenge for shoulder surgeons. Poor outcomes have been demonstrated in patients with anatomic total shoulder arthroplasty (aTSA) left in retroversion. Reverse total shoulder arthroplasty (rTSA) yields good midterm results. There is a paucity of studies comparing aTSA to rTSA in patients with glenohumeral arthritis and B2 glenoids. The purpose of this study was to compare the results of aTSA vs. rTSA in patients with glenohumeral arthritis with B2 glenoid morphology.
We performed a retrospective review of patients who underwent total shoulder arthroplasty by a single surgeon. Preoperative computed tomography was used to determine glenoid type based on the modified Walch classification. Patients with B2 glenoid morphology were included in the study. Patients who had evidence of a rotator cuff tear or less than two years of follow-up were excluded. Patients were categorized by procedure type (aTSA vs. rTSA). Preoperative glenoid version, glenoid inclination, and posterior humeral head subluxation were measured using computed tomography. Patient reported outcome measures, active range of motion, and complications requiring revision (instability, rotator cuff insufficiency, infection, component loosening) were recorded. Postoperative glenoid version, glenoid inclination, and evidence of humeral head decentering were evaluated on standard shoulder radiographs. Statistical analysis was performed and results are presented as mean ± standard deviation.
A total of 224 patients were included. One hundred sixty-two patients underwent aTSA and 62 underwent rTSA. The mean length of follow-up was 25.6 ± 1.95 months for the rTSA group and 32.8 ± 2.27 for the aTSA group ( = .002). Patients who underwent rTSA were significantly older ( < .001) and had a significantly higher proportion of females ( = .019). Postoperatively patients in the aTSA group had significantly better external rotation ( < .001) and internal rotation (IR) compared to the rTSA group ( < .001). There were no differences in patient reported outcome measures between the two groups. No patients in the aTSA group had recurrent posterior humeral head subluxation. Eight complications requiring revision occurred, 4 in each group. One patient who underwent aTSA had evidence of glenoid loosening. There was no evidence of glenoid loosening in the rTSA group.
aTSA and rTSA can produce good results in patients with B2 glenoid morphology with low rates of revision with appropriate patient selection. aTSA may result in improved range of motion that may not be clinically relevant.
患有Walch B2型肩胛盂形态的盂肱关节炎患者给肩部外科医生带来了挑战。解剖型全肩关节置换术（aTSA）后倾的患者预后较差。反向全肩关节置换术（rTSA）可产生良好的中期效果。在患有盂肱关节炎和B2型肩胛盂的患者中，比较aTSA和rTSA的研究较少。本研究的目的是比较aTSA与rTSA在患有B2型肩胛盂形态的盂肱关节炎患者中的结果。
我们对由单一外科医生进行全肩关节置换术的患者进行了回顾性研究。术前计算机断层扫描用于根据改良的Walch分类确定肩胛盂类型。具有B2型肩胛盂形态的患者纳入研究。有肩袖撕裂证据或随访时间少于两年的患者被排除。患者按手术类型（aTSA与rTSA）分类。使用计算机断层扫描测量术前肩胛盂旋转角度、肩胛盂倾斜度和肱骨头后脱位。记录患者报告的结局指标、活动范围以及需要翻修的并发症（不稳定、肩袖功能不全、感染、假体松动）。在标准肩部X线片上评估术后肩胛盂旋转角度、肩胛盂倾斜度和肱骨头偏心的证据。进行统计分析，结果以平均值±标准差表示。
共纳入224例患者。162例患者接受了aTSA，62例接受了rTSA。rTSA组的平均随访时间为25.6±1.95个月，aTSA组为32.8±2.27个月（P = 0.002）。接受rTSA的患者年龄显著更大（P < 0.001），女性比例显著更高（P = 0.019）。与rTSA组相比，aTSA组术后患者的外旋（P < 0.001）和内旋（IR）（P < 0.001）明显更好。两组患者报告的结局指标没有差异。aTSA组没有患者出现复发性肱骨头后脱位。发生了8例需要翻修的并发症，每组4例。1例接受aTSA的患者有肩胛盂松动的证据。rTSA组没有肩胛盂松动的证据。
aTSA和rTSA在具有B2型肩胛盂形态的患者中可以产生良好的效果，通过适当的患者选择翻修率较低。aTSA可能会导致活动范围改善，但可能在临床上不相关。
