Hao Kevin A, Simcox Trevor G, Hones Keegan M, Wright Jonathan O, Wright Thomas W, LaMonica Tyler, Schoch Bradley S, King Joseph J
From the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL (Hao, Hones, Jonathan O. Wright, Thomas W. Wright, LaMonica, and King), the Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX (Simcox), and the Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL (Schoch).
J Am Acad Orthop Surg. 2025 Jun 20. doi: 10.5435/JAAOS-D-24-01296.
To investigate whether patients who initially underwent anatomic total shoulder arthroplasty (aTSA) for glenohumeral osteoarthritis and were subsequently revised to reverse TSA (rTSA) due to rotator cuff failure or glenoid loosening ultimately attained a similar clinical outcome compared with those who underwent primary rTSA and identify predictors of poor outcomes in the former population.
We did a single-center retrospective review of 63 shoulders who underwent revision rTSA after primary aTSA that failed due to glenoid component loosening (n = 32), rotator cuff failure (n = 24), or recurrent instability (n = 7). Pain and functional outcomes at minimum 2-year follow-up were compared between patients undergoing revision rTSA (n = 45) and a matched control group of primary rTSAs performed for primary osteoarthritis with an intact rotator cuff. Predictors of a poor American Shoulder and Elbow Surgeons score and baseplate loosening in the former cohort were identified.
After revision rTSA, patients demonstrated statistically significant (P < 0.05) improvement in overhead motion, functional outcome scores, and pain but no improvement in external or internal rotation. A 35% complication rate was observed, most commonly baseplate loosening (21%). The implant survivorship following revision rTSA was 97% after 2 years and 75% after 5 years. No notable differences in any outcome scores, range of motion, shoulder strength, or pain measures were found between revision rTSAs and matched primary rTSA controls at a mean of 8 years since index surgery. Humeral stem retention was independently associated with poorer postoperative American Shoulder and Elbow Surgeons scores, whereas a lesser interval between index and revision surgery and use of a structural bone graft were associated with a higher risk of baseplate loosening.
Patients who undergo aseptic revision rTSA after failed primary aTSA for cuff-intact glenohumeral osteoarthritis attain similar pain and functional outcomes compared with those who underwent primary rTSA when matched by time since index surgery.
Level III, Case-Control Study.
探讨最初因盂肱关节骨关节炎接受解剖型全肩关节置换术（aTSA），随后因肩袖损伤或肩胛盂松动而翻修为反式全肩关节置换术（rTSA）的患者，与接受初次rTSA的患者相比，最终是否能获得相似的临床结局，并确定前一组患者预后不良的预测因素。
我们对63例因肩胛盂假体松动（n = 32）、肩袖损伤（n = 24）或复发性不稳定（n = 7）导致初次aTSA失败后接受翻修rTSA的患者进行了单中心回顾性研究。对接受翻修rTSA的患者（n = 45）和为原发性骨关节炎且肩袖完整的患者进行初次rTSA的匹配对照组，比较至少2年随访时的疼痛和功能结局。确定前一组患者美国肩肘外科医师协会评分低和基板松动的预测因素。
翻修rTSA后，患者在上举活动、功能结局评分和疼痛方面有统计学意义的改善（P < 0.05），但外旋或内旋无改善。观察到并发症发生率为35%，最常见的是基板松动（21%）。翻修rTSA后2年植入物存活率为97%，5年后为75%。自初次手术平均8年后，翻修rTSA与匹配的初次rTSA对照组在任何结局评分、活动范围、肩部力量或疼痛指标方面均未发现显著差异。肱骨干保留与术后美国肩肘外科医师协会评分较差独立相关，而初次手术与翻修手术之间的间隔较短以及使用结构性骨移植与基板松动风险较高相关。
因肩袖完整的盂肱关节骨关节炎初次aTSA失败后接受无菌翻修rTSA的患者，与初次rTSA患者相比，在按初次手术时间匹配时，获得相似的疼痛和功能结局。
III级，病例对照研究。
