使用Aramis© 种植体基板进行初次反式肩关节置换术后无菌性关节盂基板松动的发生率及危险因素，随访至少两年。

Incidence and risk factors for aseptic glenoid baseplate loosening in primary reverse shoulder arthroplasty using the Aramis© implant baseplate with a minimum of two years follow-up.

作者信息

Klein Aurélien, Nové-Josserand Laurent, Collotte Philippe, Gunst Stanislas

机构信息

Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 avenue Paul Santy, 69008 Lyon, France.

出版信息

J Shoulder Elbow Surg. 2025 Sep 10. doi: 10.1016/j.jse.2025.07.030.

DOI:10.1016/j.jse.2025.07.030

PMID:40939827

Abstract

BACKGROUND

Reverse total shoulder arthroplasty (rTSA) has become the gold standard treatment for many shoulder pathologies. Aseptic glenoid baseplate loosening (AGBL) is a serious complication of rTSA that may lead to revision surgery. The aim of this study was to evaluate the incidence of AGBL in patients who underwent rTSA using a lateralized-glenoid lateralized-humerus implant with a convex baseplate. The secondary objective was to identify risk factors for AGBL.

METHODS

This retrospective multicenter study included 194 rTSA with the same prosthesis design (Aramis) implanted between 2013 and 2019 by two senior surgeons with a minimum follow-up of 2 years. All patients were evaluated clinically and radiographically before surgery and at last follow-up. Demographic variables, implant characteristics, operative parameters, and rates of scapular notching and of bone spurs at the level of the inferior glenoid pillar were compared between cases with and without AGBL.

RESULTS

AGBL occurred after 11/194 rTSA (5.7%). The mean follow-up was 4.2 ± 1.8 years (range, 2 to 9.3 years). In univariable analysis, AGBL was significantly associated (P < .05) with intraoperative glenoid fracture, high-positioned glenoid component, and insufficiently distal rTSA (low distalization shoulder angle). Spurs at the level of the inferior glenoid pillar were also significantly more prevalent in the AGBL group (P = .006). In multivariable analysis, the variables independently associated with AGBL were intraoperative glenoid fracture (odds ratio (OR) 15, 95% confidence interval [1.4; 157]; P =.027), and excessively lateral positioning of the implant (high lateralization shoulder angle) (OR, 1.07 [1.00; 1.14]; P = .045).

CONCLUSIONS

In this series of 194 rTSA with a lateralized-glenoid lateralized-humeral implant and convex baseplate, the incidence of AGBL at a mean follow-up of 4.2 years was 5.7%. AGBL was independently associated with intraoperative glenoid fracture and excessively lateral positioning of the implant.

LEVEL OF EVIDENCE

Level IV; Case Series; Treatment Study.

摘要

背景

反向全肩关节置换术（rTSA）已成为许多肩部疾病的金标准治疗方法。无菌性肩胛盂基板松动（AGBL）是rTSA的一种严重并发症，可能导致翻修手术。本研究的目的是评估使用带凸基板的外侧化肩胛盂-外侧化肱骨植入物进行rTSA的患者中AGBL的发生率。次要目标是确定AGBL的危险因素。

方法

这项回顾性多中心研究纳入了194例采用相同假体设计（Aramis）的rTSA，由两位资深外科医生在2013年至2019年间植入，最小随访时间为2年。所有患者在手术前和最后一次随访时均进行了临床和影像学评估。比较了发生和未发生AGBL的病例之间的人口统计学变量、植入物特征、手术参数以及肩胛盂切迹和肩胛盂下柱水平骨赘的发生率。

结果

194例rTSA中有11例（5.7%）发生了AGBL。平均随访时间为4.2±1.8年（范围为2至9.3年）。在单变量分析中，AGBL与术中肩胛盂骨折、肩胛盂组件高位放置以及rTSA远端不足（远端化肩角低）显著相关（P<.05）。肩胛盂下柱水平的骨赘在AGBL组中也明显更常见（P=.006）。在多变量分析中，与AGBL独立相关的变量是术中肩胛盂骨折（比值比[OR]15，95%置信区间[1.4；157]；P=.027）以及植入物过度外侧定位（高外侧化肩角）（OR，1.07[1.00；1.14]；P=.045）。