Heterotopic ossifications in revision reverse shoulder arthroplasty and their impact on long-term outcomes.

IF 2.8 3区医学 Q1 ORTHOPEDICS

Journal of Orthopaedic Surgery and Research Pub Date : 2025-10-08 DOI:10.1186/s13018-025-06312-y

Raphael Trefzer, Michel Leisner, Mustafa Hariri, Johannes Weishorn, Paul Mick, Matthias Bülhoff

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引用次数: 0

Abstract

Background: Heterotopic ossifications (HO) are frequently observed after joint replacement surgery and may impair joint mobility and clinical outcomes. The incidence and clinical relevance of HO in revision reverse shoulder arthroplasty (RSA) remain unclear. The purpose of this study was to investigate the (1) incidence of HO and (2) the influence of HO on long-term clinical outcomes in a selected patient cohort who underwent revision RSA.

Methods: We retrospectively identified patients who underwent revision RSA with a minimum follow-up of 5 years. A total of 37 patients (20 female; mean age, 66 years) were examined after a mean follow-up of 10 years. Clinical outcomes included the Constant-Murley Score (CMS) and its age- and sex-adjusted form (aCMS). HO were evaluated on radiographs by two independent raters and graded using a modified Brooker classification. Inter-rater agreement was calculated using Cohen's Kappa. Statistical comparison of means was conducted using student's t-test for normally distributed data. Chi square tests were used to assess the incidence between groups. Spearman's Rho was calculated to investigate correlations between HO grades and clinical outcome.

Results: HO were observed in 28 of 37 patients (75%). Inter-rater agreement was substantial (Cohen's Kappa = 0.63). The mean aCMS at 10 years was 70.7%; 62% of patients (23/37) reached the patient-acceptable symptomatic state (PASS, defined as aCMS > 61%). HO incidence did not differ between one-stage and two-stage revisions (77% vs. 74%). Higher HO grades were negatively correlated with CMS (r = - 0.412; p = 0.013). Patients with HO grade ≥ 2 had significantly lower aCMS values (61.5% vs. 81.6%; p = 0.03) and were less likely to reach the PASS (40% vs. 88%; p = 0.0003).

Conclusion: HO show a high incidence in revision RSA and are clinically relevant as they are associated with inferior long-term clinical outcomes in grade 2 or higher. Future studies should emphasize on preventive strategies in patients undergoing revision RSA.

Level of evidence iii: Therapeutic study.

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改良肩关节置换术中的异位骨化及其对长期预后的影响。

背景：异位骨化（HO）在关节置换术后经常被观察到，并可能影响关节的活动和临床结果。逆行肩关节置换术（RSA）中HO的发生率和临床相关性尚不清楚。本研究的目的是调查(1)HO的发病率和(2)HO对经过翻修RSA的患者队列的长期临床结果的影响。方法：我们回顾性地确定了接受RSA翻修的患者，随访时间至少为5年。37例患者（女性20例，平均年龄66岁）平均随访10年。临床结果包括Constant-Murley评分（CMS）及其年龄和性别调整表（aCMS）。由两名独立评分者在x线片上对HO进行评估，并使用改进的Brooker分级法进行分级。评级机构间的协议是使用科恩的Kappa计算的。对正态分布数据采用学生t检验进行均值统计比较。卡方检验用于评估组间发病率。计算Spearman's Rho以研究HO分级与临床结果之间的相关性。结果：37例患者中28例（75%）出现HO。评分者之间的一致是实质性的（Cohen’s Kappa = 0.63）。10年平均aCMS为70.7%；62%的患者（23/37）达到了患者可接受的症状状态（PASS，定义为aCMS bb0.61%）。一期和二期手术的HO发生率无差异（77% vs. 74%）。高HO分级与CMS呈负相关（r = - 0.412; p = 0.013）。HO分级≥2的患者aCMS值显著降低（61.5%比81.6%,p = 0.03），达到PASS的可能性较低（40%比88%，p = 0.0003）。结论：HO在翻修后的RSA中发病率很高，并且与临床相关，因为它们与2级或更高级别的较差长期临床结果相关。未来的研究应侧重于改良RSA患者的预防策略。证据等级iii：治疗性研究。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.