David W Zeltser, Kathryn E Royse, Heather A Prentice, Chelsea Reyes, Elizabeth W Paxton, Ronald A Navarro, Abtin Foroohar
{"title":"桡骨头关节置换术后松配与压配骨柄与手术再介入风险：一项针对 1575 名患者的美国队列研究。","authors":"David W Zeltser, Kathryn E Royse, Heather A Prentice, Chelsea Reyes, Elizabeth W Paxton, Ronald A Navarro, Abtin Foroohar","doi":"10.1016/j.jse.2024.07.050","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Radial head arthroplasty (RHA) is performed with increasing frequency for reconstruction of comminuted radial head fractures. Implants can be categorized by stem design, either loose fit or press fit. Currently, the RHA literature does not suggest one implant type is superior to another based on revision and reoperation rates, although most RHA outcome studies have small numbers of patients with few events to detect a difference. This study evaluated the association between stem design and risk of revision and reoperation after RHA.</p><p><strong>Methods: </strong>1575 patients aged ≥18 years who underwent primary RHA within a US-based healthcare system were identified (2009-2021). Revision following the index RHA was the primary outcome of interest; ipsilateral reoperation was a secondary outcome. Multivariable Cox proportional hazard regression was used to evaluate the risk of outcomes by loose versus press fit with the adjustment for race/ethnicity, ASA classification, region, surgeon RHA volume, and simultaneous ipsilateral extremity procedures.</p><p><strong>Results: </strong>Of the 1575 RHA, 681 (43.2%) received a loose fit stem. The cumulative revision probability was 2.6% for loose fit and 3.5% for press fit. In adjusted analysis, we did not observe a difference in risk of revision (HR=0.78, 95% CI=0.41-1.46) or reoperation (HR=0.73, 95% CI=0.43-1.25). Additionally, there were no observed differences in risk of revision (HR=0.62, 95% CI=0.28-1.38) or reoperation (HR=0.90, 95% CI=0.48-1.71) in the patient subgroup who underwent additional procedures in the same extremity at the time of RHA.</p><p><strong>Conclusion: </strong>In this large multi-center cohort of 1575 primary RHA, we did not observe a difference in risk of revision or reoperation following RHA based upon stem design. The choice between using an implant with a loose or press fit stem may be based more on surgeon familiarity, implant availability and cost, and ease of use.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Loose fit versus press fit stems and risk for surgical reintervention following radial head arthroplasty: A US-based cohort study of 1575 patients.\",\"authors\":\"David W Zeltser, Kathryn E Royse, Heather A Prentice, Chelsea Reyes, Elizabeth W Paxton, Ronald A Navarro, Abtin Foroohar\",\"doi\":\"10.1016/j.jse.2024.07.050\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Radial head arthroplasty (RHA) is performed with increasing frequency for reconstruction of comminuted radial head fractures. Implants can be categorized by stem design, either loose fit or press fit. Currently, the RHA literature does not suggest one implant type is superior to another based on revision and reoperation rates, although most RHA outcome studies have small numbers of patients with few events to detect a difference. This study evaluated the association between stem design and risk of revision and reoperation after RHA.</p><p><strong>Methods: </strong>1575 patients aged ≥18 years who underwent primary RHA within a US-based healthcare system were identified (2009-2021). Revision following the index RHA was the primary outcome of interest; ipsilateral reoperation was a secondary outcome. Multivariable Cox proportional hazard regression was used to evaluate the risk of outcomes by loose versus press fit with the adjustment for race/ethnicity, ASA classification, region, surgeon RHA volume, and simultaneous ipsilateral extremity procedures.</p><p><strong>Results: </strong>Of the 1575 RHA, 681 (43.2%) received a loose fit stem. The cumulative revision probability was 2.6% for loose fit and 3.5% for press fit. In adjusted analysis, we did not observe a difference in risk of revision (HR=0.78, 95% CI=0.41-1.46) or reoperation (HR=0.73, 95% CI=0.43-1.25). Additionally, there were no observed differences in risk of revision (HR=0.62, 95% CI=0.28-1.38) or reoperation (HR=0.90, 95% CI=0.48-1.71) in the patient subgroup who underwent additional procedures in the same extremity at the time of RHA.</p><p><strong>Conclusion: </strong>In this large multi-center cohort of 1575 primary RHA, we did not observe a difference in risk of revision or reoperation following RHA based upon stem design. The choice between using an implant with a loose or press fit stem may be based more on surgeon familiarity, implant availability and cost, and ease of use.</p>\",\"PeriodicalId\":50051,\"journal\":{\"name\":\"Journal of Shoulder and Elbow Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-09-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Shoulder and Elbow Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jse.2024.07.050\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Shoulder and Elbow Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jse.2024.07.050","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Loose fit versus press fit stems and risk for surgical reintervention following radial head arthroplasty: A US-based cohort study of 1575 patients.
Introduction: Radial head arthroplasty (RHA) is performed with increasing frequency for reconstruction of comminuted radial head fractures. Implants can be categorized by stem design, either loose fit or press fit. Currently, the RHA literature does not suggest one implant type is superior to another based on revision and reoperation rates, although most RHA outcome studies have small numbers of patients with few events to detect a difference. This study evaluated the association between stem design and risk of revision and reoperation after RHA.
Methods: 1575 patients aged ≥18 years who underwent primary RHA within a US-based healthcare system were identified (2009-2021). Revision following the index RHA was the primary outcome of interest; ipsilateral reoperation was a secondary outcome. Multivariable Cox proportional hazard regression was used to evaluate the risk of outcomes by loose versus press fit with the adjustment for race/ethnicity, ASA classification, region, surgeon RHA volume, and simultaneous ipsilateral extremity procedures.
Results: Of the 1575 RHA, 681 (43.2%) received a loose fit stem. The cumulative revision probability was 2.6% for loose fit and 3.5% for press fit. In adjusted analysis, we did not observe a difference in risk of revision (HR=0.78, 95% CI=0.41-1.46) or reoperation (HR=0.73, 95% CI=0.43-1.25). Additionally, there were no observed differences in risk of revision (HR=0.62, 95% CI=0.28-1.38) or reoperation (HR=0.90, 95% CI=0.48-1.71) in the patient subgroup who underwent additional procedures in the same extremity at the time of RHA.
Conclusion: In this large multi-center cohort of 1575 primary RHA, we did not observe a difference in risk of revision or reoperation following RHA based upon stem design. The choice between using an implant with a loose or press fit stem may be based more on surgeon familiarity, implant availability and cost, and ease of use.
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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