Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older.,International Orthopaedics

当前位置： X-MOL 学术 › Int. Orthop. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older.
International Orthopaedics ( IF 2.0 ) Pub Date : 2020-03-04 , DOI: 10.1007/s00264-020-04501-4
Giovanni Merolla _{1,

2} , Mauro De Cupis ₃ , Gilles Walch ₄ , Vincenzo De Cupis ₃ , Elisabetta Fabbri ₅ , Francesco Franceschi ₆ , Claudio Ascani ₇ , Paolo Paladini ₁ , Giuseppe Porcellini ₈

Affiliation

Abstract

Background

We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older.

Methods

Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant–Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded.

Results

RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001).

Conclusion

RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.

中文翻译：

影响原发性骨关节炎的解剖学和全肩关节置换术适应症的术前因素以及年龄在70岁及以上患者的结局比较。

摘要

背景

我们评估了影响原发性骨关节炎的解剖和反向全肩关节置换术（TSA和RTSA）适应症的术前因素，并比较了70岁及以上患者的结局。

方法

58例患者接受了全聚乙烯类鹰嘴成分（TSGC）的TSA或具有/不具有类鹰嘴偏侧化和相同的弯曲短茎肱骨成分的RTSA。术前和术后记录活动性前，外侧抬高（AAE，ALE），内外旋（IR，ER），疼痛和Constant-Murley评分（CS）。评估术前肩袖（RC）脂肪浸润（FI）和改良的Walch关节盂形态。记录肱骨和盂关节的影像学结果。

结果

RTSA年龄大于TSA患者（p = 0.006），术前AAE（p <0.001），ALE（p <0.001），IR（p = 0.002），疼痛（p = 0.008）和CS（p <0.001）低）和更大的棘上肌FI（p <0.001）。平均28.8个月，两种植入物的术后评分和并发症发生率均显着不同。两组术后AAE，ER和IR相似。TSA中ALE较高（p = 0.006）；RTSA的AAE和ALE delta得分更高（p = 0.045和p 分别为0.033）。在TSA APGC周围，射线可透线率高于RTSA底板（p = 0.001）。高档RC FI会对移动性改善产生不利影响。TSA的肱骨皮质变薄明显更高（p = 0.001）。