Adam Mahmoud, Lädermann Alexandre, Khalifa Ahmed A, Denard Patrick J, Lacerda Felipe, Collin Philippe
Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France.
Luxor University, Luxor, Egypt.
Eur J Orthop Surg Traumatol. 2025 Jun 25;35(1):278. doi: 10.1007/s00590-025-04385-3.
BACKGROUND/OBJECTIVES: Improving shoulder range of motion (ROM), including functional internal rotation (fIR) after reverse shoulder arthroplasty (RSA), is crucial for the patient's daily activity. We aimed to investigate the potential differences in shoulder ROM and fIR after RSA based on the glenosphere size (36 mm vs. 39 mm) and to evaluate if increasing the glenosphere size affects shoulder ROM and fIR.
A retrospective analysis was performed on patients who had RSA with a minimum follow-up of 2 years postoperatively. A 36 mm or 39 mm glenosphere was utilized based on surgeon preference. Functional outcomes were evaluated using the constant score (CS) and simple shoulder value (SSV). Shoulder ROM assessment included evaluating passive and active external rotation (ER) and forward elevation, while fIR was assessed and classified into type I if the hand was blocked to the buttock, type II lumbar sliding, and type III smooth motion. Type I was non-functional, while types II and III were functional.
A total of 222 patients were eligible for inclusion, having a mean age of 72 ± 8 years; 109 had a glenosphere 36 mm (Group 1), and 113 had a glenosphere 39 mm (Group 2). After a mean follow-up of 24.7 ± 4.1 months, the overall CS significantly improved from 42.8 ± 15.3 preoperatively to 73.4 ± 11.8 at the last follow-up (p < 0.01), and the SSV increased from 43.6 ± 16.7 to 79.7 ± 13.2 (p < 0.01), however, patients in group 2 had higher values in the strength component of the Constant Score (11.4 ± 6.1 vs. 8.7 ± 4.7, p < 0.01) and better active ER (29.6 ± 19.8 vs. 22.2 ± 20.7, p < 0.01), with no significant difference in the remaining parameters. Functional categories (Type II or III at last follow-up) of fIR were achieved in 79 (72.5%) and 79 (69.9%) of the patients in groups 1 and 2, respectively, with no significant difference between both groups (p = 0.32). For active ER, sphere size 39 and preoperative active ER were significantly associated with the last follow-up active ER values (p value < 0.01), while age, gender, and BMI did not show a significant effect. In contrast, the last follow-up fIR was not affected by any of the variables, including the glenosphere size.
A larger glenosphere (39 mm vs. 36 mm) was associated with a slightly better active ER; however, the glenosphere size did not affect the fIR. Preoperative ER ROM and larger glenosphere size were significantly associated with improved last follow-up shoulder ER. Regardless of the glenosphere size, all patients achieved satisfactory functional outcomes at the last follow-up compared to their baseline values.
背景/目的：改善全肩关节置换术（RSA）后的肩关节活动范围（ROM），包括功能性内旋（fIR），对患者的日常活动至关重要。我们旨在研究基于球窝假体尺寸（36mm与39mm）的RSA术后肩关节ROM和fIR的潜在差异，并评估增加球窝假体尺寸是否会影响肩关节ROM和fIR。
对接受RSA且术后至少随访2年的患者进行回顾性分析。根据外科医生的偏好使用36mm或39mm的球窝假体。使用常数评分（CS）和简单肩关节评分（SSV）评估功能结果。肩关节ROM评估包括评估被动和主动外旋（ER）以及前屈，而fIR则进行评估，若手能触及臀部则分类为I型，若能触及腰部则为II型，若为顺畅动作则为III型。I型为无功能型，II型和III型为功能型。
共有222例患者符合纳入标准，平均年龄为72±8岁；109例使用36mm的球窝假体（第1组），113例使用39mm的球窝假体（第2组）。平均随访24.7±4.1个月后，总体CS从术前的42.8±15.3显著提高至末次随访时的73.4±ll.8（p<0.01），SSV从43.6±16.7增加至79.7±13.2（p<0.01）；然而，第2组患者在常数评分的力量部分得分更高（11.4±6.1对8.7±4.7，p<0.01），主动ER更好（29.6±19.8对22.2±20.7，p<0.01），其余参数无显著差异。第1组和第2组分别有79例（72.5%）和79例（69.9%）患者在末次随访时达到fIR功能类别（II型或III型），两组之间无显著差异（p = 0.32）。对于主动ER，39mm的球窝假体尺寸和术前主动ER与末次随访时的主动ER值显著相关（p值<0.01），而年龄、性别和BMI未显示出显著影响。相比之下，末次随访时的fIR不受任何变量的影响，包括球窝假体尺寸。
更大的球窝假体（39mm对36mm）与稍好的主动ER相关；然而，球窝假体尺寸不影响fIR。术前ER ROM和更大的球窝假体尺寸与末次随访时改善的肩关节ER显著相关。无论球窝假体尺寸如何，与基线值相比，所有患者在末次随访时均取得了满意的功能结果。
