A 10-year comparative analysis of the 2 most common reverse total shoulder arthroplasty implants (Delta Xtend and SMR) in the New Zealand Joint Registry.

IF 2.9 2区 医学 Q1 ORTHOPEDICS
Scott M Bolam, Adam Stoneham, Mei Lin Tay, Chris M A Frampton, Peter C Poon, Ryan Gao, Brendan Coleman, Adam Dalgleish
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引用次数: 0

Abstract

Hypothesis and background: As the incidence of reverse total shoulder arthroplasty (rTSA) continues to rise, better understanding of the long-term risks and complications is necessary to determine the best choice of implant. The majority (75%) of rTSAs performed in New Zealand use either SMR (Systema Multiplana Randelli; Lima-LTO) or Delta Xtend (DePuy Synthes). The aim of this registry-based study was to compare implant survival, risk of revision, and reasons for revision between the 2 most frequently used rTSA prostheses: SMR and Delta Xtend.

Methods: Using data from the New Zealand Joint Registry between 1999 and 2022, we identified 5891 patients who underwent rTSA using either SMR cementless (62.8%) or Delta Xtend prostheses (37.2%). Delta Xtend was subdivided into cementless (31.4% of total) and cemented humeral stem (5.8% of total) subgroups for analysis. Revision-free implant survival and functional outcomes (Oxford Shoulder Score [OSS] at 6 months, 5 years, and 10 years were adjusted by age, American Society of Anesthesiologists [ASA] grade, indication, sex, and surgeon volume for between-group comparisons.

Results: Ten-year revision-free implant survival was 93.0%, 92.5%, and 95.8% for Delta Xtend cemented, Delta Xtend cementless, and SMR, respectively. The Delta Xtend cemented implant had a 2-fold higher adjusted revision risk compared with both the Delta Xtend cementless and the SMR cementless implants (hazard ratio [HR] = 2.04, P = .011; and HR = 2.59, P < .001, respectively). There was no significant difference between the Delta Xtend cementless and SMR cementless groups (HR = 1.28, P = .129). The Delta Xtend cemented group was significantly (P ≤ .01) older, had more comorbidities (ASA 3 or 4), female, and indicated for fracture compared with other groups. The most common reason(s) for revision was aseptic loosening and infection for Delta Xtend cementless; aseptic loosening, instability or dislocation, and infection for Delta Xtend cemented; and aseptic loosening alone for SMR cementless. Average OSS was significantly lower in Delta Xtend cemented compared with Delta Xtend cementless and SMR cementless at 6 months (30.8, 35.9 vs. 35.6, respectively, P < .01) and 5 years (37.4, 40.7 vs. 39.5, respectively, P < .01).

Conclusions: Overall, we found that the Delta Xtend cemented group had more than a 2-fold risk of revision compared with Delta Xtend cementless and SMR cementless groups, whereas there was no difference in revision risk between the Delta Xtend and SMR cementless prostheses. As the incidence of rTSA continues to rise, better understanding of the long-term risks and complications is necessary to determine the best choice of implant.

新西兰关节注册中心对两种最常见的反向全肩关节置换术植入物(Delta Xtend和SMR)的10年比较分析。
假设与背景:随着逆行全肩关节置换术(RTSA)的发生率持续上升,更好地了解长期风险和并发症是确定最佳植入物选择的必要条件。在新西兰进行的大多数RTSA(75%)使用SMR (Systema Multiplana Randelli, Lima-LTO,意大利)或Delta Xtend (DePuy Synthes,美国)。这项基于注册表的研究的目的是比较两种最常用的RTSA假体:SMR和Delta Xtend的种植体存活率、翻修风险和翻修原因。方法:使用1999年至2022年新西兰联合登记处的数据,我们确定了5,891例使用SMR无骨水泥(62.8%)或Delta Xtend假体(37.2%)进行RTSA的患者。Delta Xtend被细分为无骨水泥(31.4%)和骨水泥肱骨干(5.8%)亚组进行分析。在6个月、5年和10年时,根据年龄、美国麻醉医师协会(ASA)分级、适应证、性别和手术量调整无修复假体存活和功能结局(牛津肩关节评分[OSS])进行组间比较。结果:Delta Xtend骨水泥、Delta Xtend无骨水泥和SMR的10年无修复种植体存活率分别为93.0%、92.5%和95.8%。Delta Xtend骨水泥种植体的调整翻修风险比Delta Xtend无骨水泥种植体和SMR无骨水泥种植体高2倍(风险比[HR]=2.04, p=0.011;结论:总体而言,我们发现Delta Xtend骨水泥组的翻修风险是Delta Xtend无骨水泥组和SMR无骨水泥组的两倍以上,而Delta Xtend和SMR无骨水泥假体的翻修风险没有差异。随着逆行全肩关节置换术(RTSA)的发生率持续上升,更好地了解长期风险和并发症是确定最佳植入物选择的必要条件。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
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.
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