Complications and revisions in metal-backed anatomic total shoulder arthroplasty: a comparative study of revision rates between stemless and stemmed humeral components

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery Pub Date : 2025-02-01 DOI:10.1016/j.jse.2024.05.017

Moritz Kraus , Johanna Illner , Mara Warnhoff MD , Moritz Brunner , Tim Schneller , Asimina Lazaridou PhD , MD Markus Scheibel PhD

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引用次数: 0

Abstract

Background

The primary objective of this study was to evaluate and compare the incidence of complications and revision surgeries between in 2 of convertible metal-back glenoid systems in total shoulder arthroplasty (aTSA) groups over a follow-up period of up to 5 years.

Methods

A retrospective analysis included 69 shoulders from 65 patients with primary aTSA. Patients were divided into group 1 (n = 31), receiving convertible cementless stemmed aTSA (Lima SMR) and group 2 (n = 38), receiving humeral head replacement aTSA (Arthrex, Eclipse) both with metal-back glenoid components. Clinical and radiological assessments were conducted at 2, 5, and 10 years postoperatively. Assessments included the following: Constant Score, Disabilities of the Arm, Shoulder, and Hand, Shoulder Pain and Disability Index, Subjective Shoulder Value, Glenohumeral Distance, Critical Shoulder Angle, and Lateral Acromion Index. In addition, we compared complications, revision rates, and survival rates between groups using Kaplan-Maier curves and Log-Rank-test.

Results

Baseline demographics and preoperative outcome scores showed no significant differences between groups (P ≥ .05). The overall revision rate did not significantly differ between groups (group 1:32% vs. group 2:24%, P = .60), nor did the mean time to revision (P = .27). The mean follow-up was 71 ± 41 months (group 1: 94 ± 48 months, group 2: 53 ± 23 months, P < .001). Kaplan-Meier analysis showed similar midterm survival probabilities (P = .94). Revision reasons included rotator cuff insufficiency (n = 4 in group 1, n = 2 in group 2) and glenoid wear/loosening (n = 5 in group 1, n = 7 in group 2). Interestingly, group 1 demonstrated no occurrence of glenoid metal baseplate or humeral loosening, while complex revisions were more common in the group 2. At 2 and 5 years, nonrevised patients in both groups had similar outcome scores.

Conclusion

Metal-backed glenoid implants in combination with both stemless and stemmed humeral components in aTSA exhibit comparable revision rates and survival probabilities. Rotator cuff insufficiency and polyethylene wear are the 2 most common complications leading to revision. To facilitate ongoing monitoring and optimize patient safety, we implemented a modification in the follow-up protocol, transitioning to annual appointments or earlier when necessary. This study underscores the unsolved disadvantages in metal-back components and the importance of a midterm to long-term longitudinal assessment of those patients.

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金属支撑解剖全肩关节成形术的并发症和翻修：无茎与有茎肱骨组件翻修率比较研究》。

研究背景本研究的主要目的是评估和比较两种可转换金属后盂系统在全肩关节置换术（aTSA）中的并发症和翻修手术的发生率，随访时间长达五年：回顾性分析包括65名初诊aTSA患者的69个肩关节。患者被分为第1组（31人）和第2组（38人），前者接受可转换无骨水泥柄肩关节置换术（Lima SMR），后者接受肱骨头置换肩关节置换术（Arthrex，Eclipse），两组均使用金属后盂部件。术后2年、5年和10年进行临床和放射学评估。评估内容包括恒定评分、DASH、SPADI、SSV、盂肱距离、临界肩角和外侧髋臼指数。此外，我们还使用 Kaplan-Maier 曲线和 Log-Rank 检验比较了各组之间的并发症、翻修率和存活率：结果：基线人口统计学和术前结果评分显示组间无显著差异（P≥0.05）。组间总翻修率无明显差异（第一组：32%；第二组：24%，P=0.60），平均翻修时间也无明显差异（P=0.27）。平均随访时间为71±41个月（第1组：94±48个月；第2组：53±23个月；P=0.05）：金属支撑盂体植入物与无柄和有柄肱骨组件结合应用于 aTSA，显示出相似的翻修率和存活概率。肩袖功能不全和聚乙烯磨损是导致翻修的两种最常见并发症。为便于持续监测和优化患者安全，我们对随访方案进行了修改，改为每年一次或在必要时提前预约。这项研究强调了金属后背组件尚未解决的缺点，以及对这些患者进行中长期纵向评估的重要性。

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来源期刊

Journal of Shoulder and Elbow Surgery 医学-外科

CiteScore

6.50

自引率

23.30%

发文量

604

审稿时长

11.2 weeks

期刊介绍： The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.