Waseem Saima, Simpson Ashley, Leivadiotou Dimitra
Department of Trauma and Orthopaedics, Princess Alexandra Hospital, Harlow, UK.
Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, UK.
J Shoulder Elbow Surg. 2025 May 12. doi: 10.1016/j.jse.2025.03.031.
The advent of modular implants aims to minimize morbidity associated with revision of hemiarthroplasty or anatomic total shoulder arthroplasty (aTSA) to reverse shoulder arthroplasty (rTSA) by allowing retention of the humeral stem. This systematic review aimed to summarize outcomes following the use of modular implants and reasons why modular humeral stems may be revised.
A systematic review of PubMed, MEDLINE, and Embase was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines of all patients undergoing revision of a modular hemiarthroplasty or aTSA to rTSA. Primary implants, glenoid revisions, surgical technique, and opinion-based reports were excluded. Collected data included demographics, outcomes, and incidence of complications.
Three hundred eighty-one shoulders in 374 patients with a mean age of 68.6 years (range: 44-91 years) were studied, with 95 (24.9%) being male. A total of 123 hemiarthroplasties and 183 aTSA were revised to rTSA at an average of 48.9 months (range: 3-432 months) following the primary operation. The most common reason for revision was cuff failure (28 patients). Two hundred sixty-three patients underwent modular conversion and 118 underwent stem revision. Of those who underwent humeral stem revision, 23 were exchanged because stem position was deemed too proximal, 5 stems were exchanged due to loosening, and 1 was exchanged due to significant retroversion of the index implant compromising stability. Three stem revisions required osteotomy and cerclage wiring of the humerus. After a mean follow-up of 41.3 months (range: 12-91), the Constant score improved from a mean of 24.4 to 49.9 in the retention group, but worsened from 38.5 to 35.5 after stem exchange. Stem exchange of modular implants was associated with a significantly higher risk of infection and periprosthetic fracture.
The increased use of modular stems has reduced stem revision; however, more than 30% of these implants still require revision due to intraoperative findings. Further large-volume comparative studies between revised and maintained humeral stems post revision of modular implants can adequately inform implant innovation to further improve the stem revision rate.
模块化植入物的出现旨在通过保留肱骨干，将半关节置换术或解剖型全肩关节置换术（aTSA）翻修为反向肩关节置换术（rTSA）时，尽量减少相关的发病率。本系统评价旨在总结使用模块化植入物后的结果以及模块化肱骨干可能需要翻修的原因。
根据系统评价和Meta分析的首选报告项目指南，对PubMed、MEDLINE和Embase进行系统评价，纳入所有接受模块化半关节置换术或aTSA翻修为rTSA的患者。排除初次植入物、肩胛盂翻修、手术技术和基于观点的报告。收集的数据包括人口统计学、结果和并发症发生率。
对374例患者的381个肩关节进行了研究，平均年龄68.6岁（范围：44 - 91岁），其中男性95例（24.9%）。初次手术后平均48.9个月（范围：3 - 432个月），共有123例半关节置换术和183例aTSA翻修为rTSA。翻修的最常见原因是肩袖功能不全（28例患者）。263例患者进行了模块化转换，118例进行了柄部翻修。在接受肱骨干翻修的患者中，23例因柄部位置被认为过于靠近近端而更换，5例因松动而更换，1例因初次植入物严重后倾影响稳定性而更换。3例柄部翻修需要进行肱骨截骨和环扎钢丝固定。平均随访41.3个月（范围：12 - 91个月）后，保留组的Constant评分从平均24.4提高到49.9，但在更换柄部后从38.5恶化到35.5。模块化植入物的柄部更换与感染和假体周围骨折的风险显著增加相关。
模块化柄部的使用增加减少了柄部翻修；然而，由于术中发现，超过30%的这些植入物仍需要翻修。模块化植入物翻修后，对翻修柄部和保留柄部进行进一步的大样本比较研究，可以为植入物创新提供充分信息，以进一步提高柄部翻修率。
