Hyosung Lee, Joseph J King, Jonathan O Wright, Jordyn Pendarvis, Joseph Hartman, Kevin W Farmer, Aimee M Struk, Thomas W Wright
{"title":"骨水泥使用和骨柄长度对改良肩关节置换术临床结果的影响：短骨柄无骨水泥固定是可行的选择吗？","authors":"Hyosung Lee, Joseph J King, Jonathan O Wright, Jordyn Pendarvis, Joseph Hartman, Kevin W Farmer, Aimee M Struk, Thomas W Wright","doi":"10.1016/j.jse.2025.08.013","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Revision reverse total shoulder arthroplasty (rTSA) is performed as a salvage procedure after failed shoulder arthroplasty. However, it presents substantial challenges compared to primary rTSA due to altered anatomy and compromised bone quality. This study aimed to compare clinical outcomes of revision rTSA based on the revision humeral stem fixation methods (cemented vs. cementless) and stem length (short vs. standard vs. long).</p><p><strong>Methods: </strong>We conducted a retrospective analysis using a prospectively maintained shoulder arthroplasty database from a single institution. All revision rTSAs performed between 2005 and 2023 with a minimum two-year follow-up were included. Patients were excluded for revision from a primary antibiotic spacer placed in the native shoulder or a history of multiple arthroplasty procedures. The final cohort consisted of 113 revision rTSAs (45 cemented vs. 68 cementless; 16 short vs. 79 standard vs. 18 long). Demographic data, surgical characteristics, outcome scores, active range of motion, complications and re-revision rates were compared across cohorts.</p><p><strong>Results: </strong>Revision rTSA showed no significant differences in active range of motion or outcome scores between the cemented and cementless humeral fixation cohorts. The short and standard stem cohorts demonstrated greater improvement in active abduction compared to the long stem cohort (34 ± 32 vs. 0 ± 18; P = .045; 37 ± 41 vs. 0 ± 18; P = .001). Similarly, they exhibited greater improvement in the Constant score (23.5 ± 17.7 vs. 3.5 ± 10.5; P = .018; 19.1 ± 19.5 vs. 3.5 ± 10.5; P = .012). Overall re-revision rates in the cemented and cementless cohorts were 7.2% and 14.9%, respectively, and humeral stem re-revision rates were 7.2% and 9.9%, respectively. (P = .204 and P = .746). Overall re-revision rates in the short, standard, and long stem cohorts were 3.7%, 13.7%, and 11.5%, respectively, and humeral stem re-revision rates were 0%, 10.3%, and 11.5%, respectively. (P = .361 and P = .199) CONCLUSION: The use of a short stem in revision rTSA demonstrated clinical outcomes comparable to other stem lengths. Complications and re-revision rates did not significantly differ by cement use or stem length.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison; Prognosis Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Cement Use and Stem Length on Clinical Outcomes in Revision Reverse Shoulder Arthroplasty: Is a Short Stem with Cementless Fixation a Viable Option?\",\"authors\":\"Hyosung Lee, Joseph J King, Jonathan O Wright, Jordyn Pendarvis, Joseph Hartman, Kevin W Farmer, Aimee M Struk, Thomas W Wright\",\"doi\":\"10.1016/j.jse.2025.08.013\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Revision reverse total shoulder arthroplasty (rTSA) is performed as a salvage procedure after failed shoulder arthroplasty. However, it presents substantial challenges compared to primary rTSA due to altered anatomy and compromised bone quality. This study aimed to compare clinical outcomes of revision rTSA based on the revision humeral stem fixation methods (cemented vs. cementless) and stem length (short vs. standard vs. long).</p><p><strong>Methods: </strong>We conducted a retrospective analysis using a prospectively maintained shoulder arthroplasty database from a single institution. All revision rTSAs performed between 2005 and 2023 with a minimum two-year follow-up were included. Patients were excluded for revision from a primary antibiotic spacer placed in the native shoulder or a history of multiple arthroplasty procedures. The final cohort consisted of 113 revision rTSAs (45 cemented vs. 68 cementless; 16 short vs. 79 standard vs. 18 long). Demographic data, surgical characteristics, outcome scores, active range of motion, complications and re-revision rates were compared across cohorts.</p><p><strong>Results: </strong>Revision rTSA showed no significant differences in active range of motion or outcome scores between the cemented and cementless humeral fixation cohorts. The short and standard stem cohorts demonstrated greater improvement in active abduction compared to the long stem cohort (34 ± 32 vs. 0 ± 18; P = .045; 37 ± 41 vs. 0 ± 18; P = .001). Similarly, they exhibited greater improvement in the Constant score (23.5 ± 17.7 vs. 3.5 ± 10.5; P = .018; 19.1 ± 19.5 vs. 3.5 ± 10.5; P = .012). Overall re-revision rates in the cemented and cementless cohorts were 7.2% and 14.9%, respectively, and humeral stem re-revision rates were 7.2% and 9.9%, respectively. (P = .204 and P = .746). Overall re-revision rates in the short, standard, and long stem cohorts were 3.7%, 13.7%, and 11.5%, respectively, and humeral stem re-revision rates were 0%, 10.3%, and 11.5%, respectively. (P = .361 and P = .199) CONCLUSION: The use of a short stem in revision rTSA demonstrated clinical outcomes comparable to other stem lengths. Complications and re-revision rates did not significantly differ by cement use or stem length.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison; Prognosis Study.</p>\",\"PeriodicalId\":50051,\"journal\":{\"name\":\"Journal of Shoulder and Elbow Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-10-07\",\"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.2025.08.013\",\"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.2025.08.013","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：翻修逆行全肩关节置换术（rTSA）是肩关节置换术失败后的一种救助性手术。然而，由于解剖结构的改变和骨质量的降低，与原发性rTSA相比，它提出了实质性的挑战。本研究旨在比较基于改良肱骨柄固定方法（骨水泥与非骨水泥）和柄长度（短、标准与长）的改良rTSA的临床结果。方法：我们使用来自单一机构的前瞻性维护的肩关节置换术数据库进行回顾性分析。所有在2005年至2023年期间进行的至少两年随访的修订rtsa被纳入。排除在原肩放置抗生素垫片或有多次关节置换术史的患者。最后一组包括113个改良rtsa（45个骨水泥vs 68个非骨水泥；16个短rtsa vs 79个标准rtsa vs 18个长rtsa）。比较各队列的人口统计数据、手术特征、结局评分、活动范围、并发症和再翻修率。结果：修订后的rTSA显示，骨水泥和非骨水泥肱骨固定组在活动范围或预后评分方面没有显著差异。与长柄组相比，短柄组和标准柄组在主动外展方面表现出更大的改善（34±32比0±18；P = 0.045； 37±41比0±18；P = 0.001）。同样，他们在Constant评分方面也表现出更大的改善（23.5±17.7 vs 3.5±10.5;P = 0.018; 19.1±19.5 vs 3.5±10.5;P = 0.012）。骨水泥组和非骨水泥组的总体再翻修率分别为7.2%和14.9%，肱骨干再翻修率分别为7.2%和9.9%。（P = .204和P = .746）。短柄、标准柄和长柄队列的总体再修率分别为3.7%、13.7%和11.5%，肱骨柄再修率分别为0%、10.3%和11.5%。（P = .361和P = .199）结论：在rTSA改版中，使用短杆的临床结果与其他长度的杆相当。并发症和再翻修率因骨水泥使用或骨干长度而无显著差异。证据等级:三级;回顾性队列比较；预后研究。
Impact of Cement Use and Stem Length on Clinical Outcomes in Revision Reverse Shoulder Arthroplasty: Is a Short Stem with Cementless Fixation a Viable Option?
Background: Revision reverse total shoulder arthroplasty (rTSA) is performed as a salvage procedure after failed shoulder arthroplasty. However, it presents substantial challenges compared to primary rTSA due to altered anatomy and compromised bone quality. This study aimed to compare clinical outcomes of revision rTSA based on the revision humeral stem fixation methods (cemented vs. cementless) and stem length (short vs. standard vs. long).
Methods: We conducted a retrospective analysis using a prospectively maintained shoulder arthroplasty database from a single institution. All revision rTSAs performed between 2005 and 2023 with a minimum two-year follow-up were included. Patients were excluded for revision from a primary antibiotic spacer placed in the native shoulder or a history of multiple arthroplasty procedures. The final cohort consisted of 113 revision rTSAs (45 cemented vs. 68 cementless; 16 short vs. 79 standard vs. 18 long). Demographic data, surgical characteristics, outcome scores, active range of motion, complications and re-revision rates were compared across cohorts.
Results: Revision rTSA showed no significant differences in active range of motion or outcome scores between the cemented and cementless humeral fixation cohorts. The short and standard stem cohorts demonstrated greater improvement in active abduction compared to the long stem cohort (34 ± 32 vs. 0 ± 18; P = .045; 37 ± 41 vs. 0 ± 18; P = .001). Similarly, they exhibited greater improvement in the Constant score (23.5 ± 17.7 vs. 3.5 ± 10.5; P = .018; 19.1 ± 19.5 vs. 3.5 ± 10.5; P = .012). Overall re-revision rates in the cemented and cementless cohorts were 7.2% and 14.9%, respectively, and humeral stem re-revision rates were 7.2% and 9.9%, respectively. (P = .204 and P = .746). Overall re-revision rates in the short, standard, and long stem cohorts were 3.7%, 13.7%, and 11.5%, respectively, and humeral stem re-revision rates were 0%, 10.3%, and 11.5%, respectively. (P = .361 and P = .199) CONCLUSION: The use of a short stem in revision rTSA demonstrated clinical outcomes comparable to other stem lengths. Complications and re-revision rates did not significantly differ by cement use or stem length.
Level of evidence: Level III; Retrospective Cohort Comparison; Prognosis Study.
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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