Revision rates between obese and non-obese total shoulder arthroplasty patients: An Australian registry data study.

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery Pub Date : 2025-07-14 DOI:10.1016/j.jse.2025.05.036

James Randolph Onggo, Richard Jamieson, Peiyao Du, David R J Gill, Kemble Wang

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引用次数: 0

Abstract

Background: Obesity is an epidemic more apparent in many developed countries, like Australia. The effect upon total shoulder replacement (TSR) is not clear, with different studies reporting varying conclusions. This registry-based study offers a large-scale analysis of the effects of obesity on the risk of revision in anatomic TSR (aTSR) and reverse TSR (rTSR) for various indications.

Methods: This is an observational cohort analysis of data from a national arthroplasty registry. Primary aTSR for osteoarthritis, and primary rTSR for cuff arthropathy or fracture performed between January 2015 and December 2022 in Australia were included. Procedures were stratified by body mass index (BMI) groups and the cumulative percentage of revision (CPR) was compared between groups. The analyses were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazards models.

Results: There were 9,549 primary aTSR for osteoarthritis, 13,920 primary rTSR for cuff arthropathy and 4685 primary rTSR for fractures. In rTSR indicated for fracture, obese class III had an increased all-cause revision risk compared to normal BMI patients (HR=1.87, 95%CI: 1.13-3.10, p=0.014) throughout the entire follow-up period. In contrast, all-cause revision rates for aTSR for osteoarthritis and rTSR for rotator cuff arthropathy across BMI categories were not significantly different. There was an increased risk of revision for instability/dislocation in BMI class III compared to normal BMI patients after rTSR for fracture (HR=2.84, 95%CI: 1.43-5.63, p=0.002). Obese class 1 and obese class 2 patients receiving aTSR for osteoarthritis had a higher rate of revision for cuff insufficiency compared to normal BMI patients (Entire period HR=2.30, 95%CI: 1.17-4.55, p=0.016 and Entire period HR=2.10, 95%CI: 1.00-4.40, p=0.049, respectively).

Conclusion: Obesity has an increased risk of all-cause revisions and revision for instability/dislocation in patients receiving rTSR indicated for fractures. BMI was not associated with an increased risk of revision in primary aTSR indicated for osteoarthritis, nor for primary rTSR indicated for rotator cuff arthropathy. We recommend BMI class III patients undergoing rTSR for fracture to be counselled on their complication risks during the informed consenting process.

Level of evidence: Level III; Retrospective Cohort Comparison using Large Database; Prognosis Study.

查看原文本刊更多论文

肥胖和非肥胖全肩关节置换术患者的翻修率：一项澳大利亚注册数据研究。

背景：在许多发达国家，如澳大利亚，肥胖是一种更为明显的流行病。对全肩关节置换术（TSR）的影响尚不清楚，不同的研究报告了不同的结论。这项基于注册表的研究对肥胖对各种适应症解剖性TSR （aTSR）和逆行性TSR （rTSR）修正风险的影响进行了大规模分析。方法：这是一项观察性队列分析，数据来自国家关节置换术登记处。2015年1月至2022年12月期间在澳大利亚进行的骨关节炎的原发性aTSR和袖带关节病或骨折的原发性rTSR纳入研究。按体重指数（BMI）分组对手术进行分层，并比较各组间的累计修正百分比（CPR）。分析采用来自Cox比例风险模型的Kaplan-Meier估计生存率和风险比（HR）。结果：骨关节炎原发性aTSR 9549例，袖带关节病原发性rTSR 13920例，骨折原发性rTSR 4685例。在骨折的rTSR中，与正常BMI患者相比，肥胖III级患者在整个随访期间的全因翻修风险增加（HR=1.87, 95%CI: 1.13-3.10, p=0.014）。相比之下，不同BMI类别骨关节炎的aTSR和肩袖关节病的rTSR的全因修正率没有显著差异。与BMI正常的患者相比，BMI为III级的患者在骨折后进行rTSR后因不稳定/脱位进行翻修的风险增加（HR=2.84, 95%CI: 1.43-5.63, p=0.002）。与BMI正常的患者相比，接受骨关节炎aTSR治疗的肥胖1级和肥胖2级患者的袖带功能不全翻修率更高（全期HR=2.30, 95%CI: 1.17-4.55, p=0.016；全期HR=2.10, 95%CI: 1.00-4.40, p=0.049）。结论：对于接受rTSR治疗的骨折患者，肥胖增加了全因翻修和不稳定/脱位翻修的风险。BMI与骨关节炎的原发性aTSR翻修风险增加无关，也与肩袖关节病的原发性rTSR翻修风险增加无关。我们建议BMI III级骨折患者在知情同意过程中接受rTSR治疗，告知其并发症风险。证据等级:三级;基于大型数据库的回顾性队列比较预后研究。

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

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.