反向和解剖全肩关节置换术后的功能缺陷:检测真正的差异

Q4 Medicine
Jeffrey R. Hill MD , Arakua N. Welbeck MD , Jeffrey J. Olson MD , Alexander W. Aleem MD , Jay D. Keener MD , Benjamin M. Zmistowski MD
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引用次数: 0

摘要

反向全肩关节置换术(rTSA)作为肩关节骨性关节炎(GHOA)的一种可靠的治疗选择已经获得了广泛的关注。从解剖性全肩关节置换术(aTSA)到rTSA的转变主要集中在后者较低的翻修率,以及两种TSA模式的综合患者报告结果的等效性。然而,这并没有强调它们对日常活动的细微影响。本回顾性研究旨在确定经TSA治疗GHOA后患者仍然难以完成的特定任务,并评估经aTSA治疗GHOA和经rTSA治疗GHOA在执行特定日常任务能力方面的差异。方法从单一机构登记中确定接受TSA治疗GHOA后至少随访2年的患者。患者报告的结果数据来自美国肩关节外科医生(ASES)、安大略省西部肩关节骨关节炎(WOOS)指数和单一评估数值评估调查,随访2年。通过单变量分析比较两种关节置换术类型的综合评分和各单项评分。当发现某个成分存在差异时,使用多元线性回归(WOOS)或多元逻辑回归(ASES)进行进一步分析,同时控制潜在的混杂变量。所有分析均使用SPSS(28.0版本;IBM;阿蒙克,纽约州,美国)。结果2年随访发现TSA 317例(平均67.2岁,男性53.9%),解剖性TSA 219例(69.1%)。术后视觉模拟评分疼痛总体改善(P <;.001)和as评分(P <;.001),每个asa功能组件都有改进(P <;措施)。aTSA和rTSA在所有综合调查得分上均无差异(P >;酒精含量)。在整个队列中,在幕后和管理活动方面存在持续的困难。虽然rTSA患者报告术后僵硬程度较好(P = 0.02),但他们也注意到在洗背/穿胸罩(P = 0.001)、掖衬衫(P = 0.01)、做发型(P = 0.02)和将4.54公斤(10磅)举到肩膀以上(P = 0.001)等任务上更困难。即使在调整了混杂变量后,rTSA仍然是衬衫塞进能力下降的独立预测因子(WOOS, P <;.001),并穿上外套(as;P = .03)结论:本研究说明了aTSA与rTSA治疗GHOA患者术后功能的细微差异,最明显的是头顶活动和背后活动。这一知识使外科医生和患者更好地了解解剖和反向TSA治疗GHOA预期结果的真正差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Functional deficiencies following reverse and anatomic total shoulder arthroplasty: detecting true differences

Background

Reverse total shoulder arthroplasty (rTSA) has gained traction as a reliable treatment option for glenohumeral osteoarthritis (GHOA). Much of this pivot from anatomic total shoulder arthroplasty (aTSA) to rTSA has centered on the described lower revision rates in the latter, as well as the reported equivalence in composite patient-reported outcomes between the two modes of TSA. Yet, this fails to highlight the nuanced effects each can have on everyday activities. This retrospective study aims to identify specific tasks that remain difficult for patients after TSA for GHOA and assess the difference in ability to perform specific daily tasks between aTSA and rTSA for GHOA.

Methods

Patients with minimum 2-year follow-up after undergoing TSA for GHOA were identified from a single-institution registry. Patient-reported outcome data from the American Shoulder and Elbow Surgeons (ASES), Western Ontario Osteoarthritis of the Shoulder (WOOS) index, and Single Assessment Numeric Evaluation surveys were collected at 2-year follow-up. Composite scores as well as each individual component score were compared between the two arthroplasty types by univariate analysis. When a difference in a component was found, further analysis was performed using multivariate linear regression (WOOS) or a multivariate logistic regression (ASES), while controlling for potential confounding variables. All analyses were performed in SPSS (version 28.0; IBM; Armonk, NY, USA).

Results

317 TSAs were identified with two-year follow-up (mean age 67.2 years, 53.9% males), with 219 being anatomic TSA (69.1%). Postoperatively, there was gross improvement in visual analog scale pain (P < .001) and ASES scores (P < .001), with improvements noted in each ASES functional component (P < .001). No differences were noted in all composite survey scores between aTSA and rTSA (P > .15). Across the entire cohort, there was continued difficulty with behind-the-back and overhead activities. While rTSA patients reported better postoperative stiffness (P = .02), they also noted more difficulty in tasks including washing their backs/doing up a bra (ASES, P = .001), tucking in a shirt (WOOS, P = .01), styling hair (WOOS, P = .02) and lifting 4.54 kg (10 lbs) above shoulder level (ASES, P = .001). Even when adjusting for confounding variables, rTSA was an independent predictor for decreased ability to tuck in shirt (WOOS, P < .001) and put on a coat (ASES; P = .03)

Conclusion

This study illustrates the subtle differences in postoperative function in patients treated with aTSA versus rTSA for GHOA, most notably in overhead and behind-the-back activities. This knowledge provides surgeons and patients with greater understanding of the true differences in anticipated outcomes between anatomic and reverse TSA for the treatment of GHOA.
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来源期刊
Seminars in Arthroplasty
Seminars in Arthroplasty Medicine-Surgery
CiteScore
1.00
自引率
0.00%
发文量
104
期刊介绍: Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice.
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