Boulidam Dries, Macken Arno A, Kraal Tim, Alta Tjarco D W, van den Bekerom Michel P J, Lafosse Laurent, Lafosse Thibault, Buijze Geert A
Alps Surgery Institute, Clinique Générale d'Annecy, 4 Chem. de La Tour La Reine, 74000, Annecy, France.
Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Dr. Molewaterplein 40, Rotterdam, The Netherlands.
J Orthop Traumatol. 2025 Jun 4;26(1):36. doi: 10.1186/s10195-025-00854-x.
Historically, anatomical total shoulder arthroplasty (ATSA) has been the standard intervention for primary osteoarthritis in patients with an intact rotator cuff. However, there is an increasing trend towards utilizing reverse total shoulder arthroplasty (RTSA) as an alternative in specific cases. The aim of this study is to investigate the influence of the degree of retroversion, percentage of subluxation and age on the surgeon's decision-making in the choice between ATSA and RTSA in patients with primary osteoarthritis with an intact rotator cuff.
Attendees of a large international congress on (live) shoulder surgery were requested to complete a questionnaire consisting of closed and open questions regarding shoulder arthroplasty and clinical scenarios. Participants were divided into high- and low-volume surgeons (< 30 cases per year).
A total of 166 responses were collected. In total, 37 different nationalities from all six continents were represented among the respondents. The included participants had a median experience of 11 years (interquartile range, IQR: 6-18). In total, 56 (39%) participants were considered high-volume surgeons. The median degree of retroversion, the median percentage of posterior subluxation and the median age for which participants still considered performing ATSA rather than RTSA were respectively 20° (IQR: 10-20.75), 70% (IQR: 60-80) and 70 years (IQR: 65-75). Furthermore, a low degree of consensus was observed for the choice of treatment in the ten case vignettes with these factors combined. In case of significant disagreement, RTSA was preferred more often by high-volume surgeons compared with low-volume surgeons.
This case-vignette study highlights that the degree of retroversion, percentage of subluxation of the humeral head and the patient's age are important factors to consider in the surgeon's decision-making between ATSA and RTSA. However, our findings indicate limited consensus among orthopaedic surgeons concerning the precise impact of these patient-specific factors. Despite the lack of consensus, some trends can be identified. Overall, participants preferred treatment with RTSA in patients with a high degree of retroversion and older age. Treatment with ATSA was preferred in patients with a younger age, without severe glenoid retroversion and a posterior subluxation of < 80%. The level of evidence is Level V, expert opinion.
从历史上看，解剖型全肩关节置换术（ATSA）一直是肩袖完整的原发性骨关节炎患者的标准干预措施。然而，在特定情况下，使用反向全肩关节置换术（RTSA）作为替代方案的趋势正在增加。本研究的目的是调查内旋角度、半脱位百分比和年龄对肩袖完整的原发性骨关节炎患者在ATSA和RTSA之间选择时外科医生决策的影响。
要求一个大型国际（现场）肩部外科学术会议的与会者完成一份问卷，其中包括关于肩关节置换术和临床病例的封闭式和开放式问题。参与者被分为高手术量和低手术量外科医生（每年<30例手术）。
共收集到166份回复。受访者来自六大洲的37个不同国家。纳入的参与者的中位经验为11年（四分位间距，IQR：6 - 18年）。共有56名（39%）参与者被认为是高手术量外科医生。参与者仍然考虑进行ATSA而非RTSA的内旋角度中位数、后方半脱位百分比中位数和年龄中位数分别为20°（IQR：10 - 20.75°）、70%（IQR：60 - 80%）和70岁（IQR：65 - 七十五岁）。此外，在将这些因素结合起来的10个病例 vignettes 中，观察到治疗选择的共识程度较低。在存在显著分歧的情况下，与低手术量外科医生相比，高手术量外科医生更常选择RTSA。
本病例 vignette 研究强调，内旋角度、肱骨头半脱位百分比和患者年龄是外科医生在ATSA和RTSA之间决策时需要考虑的重要因素。然而，我们的研究结果表明，骨科医生对这些患者特异性因素的确切影响的共识有限。尽管缺乏共识，但可以确定一些趋势。总体而言，参与者倾向于对内旋角度大且年龄较大的患者采用RTSA治疗。对于年龄较小、无严重肩胛盂内旋且后方半脱位<80%的患者，倾向于采用ATSA治疗。证据水平为V级，专家意见。
