Does humeral fixation technique affect long-term outcomes of total shoulder arthroplasty?

IF 1.8 Q2 ORTHOPEDICS Clinics in Shoulder and Elbow Pub Date : 2023-09-01 DOI:10.5397/cise.2023.00199
Troy Li, Kenneth H Levy, Akiro H Duey, Akshar V Patel, Christopher A White, Carl M Cirino, Alexis Williams, Kathryn Whitelaw, Dave Shukla, Bradford O Parsons, Evan L Flatow, Paul J Cagle
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Abstract

Background: For anatomic total arthroscopic repair, cementless humeral fixation has recently gained popularity. However, few studies have compared clinical, radiographic, and patient-reported outcomes between cemented and press-fit humeral fixation, and none have performed follow-up for longer than 5 years. In this study, we compared long-term postoperative outcomes in patients receiving a cemented versus press-fit humeral stem anatomic arthroscopic repair.

Methods: This study retrospectively analyzed 169 shoulders that required primary anatomic total shoulder arthroplasty (aTSA). Shoulders were stratified by humeral stem fixation technique: cementation or press-fit. Data were collected pre- and postoperatively. Primary outcome measures included range of motion, patient reported outcomes, and radiographic measures.

Results: One hundred thirty-eight cemented humeral stems and 31 press-fit stems were included. Significant improvements in range of motion were seen in all aTSA patients with no significant differences between final cemented and press-fit stems (forward elevation: P=0.12, external rotation: P=0.60, and internal rotation: P=0.77). Patient reported outcome metrics also exhibited sustained improvement through final follow-up. However, at final follow-up, the press-fit stem cohort had significantly better overall scores when compared to the cemented cohort (visual analog score: P=0.04, American Shoulder and Elbow Surgeon Score: P<0.01, Simple Shoulder Test score: P=0.03). Humeral radiolucency was noted in two cemented implants and one press-fit implant. No significant differences in implant survival were observed between the two cohorts (P=0.75).

Conclusions: In this series, we found that irrespective of humeral fixation technique, aTSA significantly improves shoulder function. However, within this cohort, press-fit stems provided significantly better outcomes than cemented stems in terms of patient reported outcome scores. Level of evidence: III.

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肱骨固定技术是否影响全肩关节置换术的远期疗效?
背景:在解剖全关节镜下修复中,无骨水泥肱骨固定最近越来越受欢迎。然而,很少有研究比较骨水泥和加压肱骨固定术的临床、影像学和患者报告的结果,也没有研究进行超过5年的随访。在这项研究中,我们比较了接受骨水泥和加压肱骨干解剖关节镜修复的患者的长期术后结果。方法:本研究回顾性分析了169例需要一期解剖性全肩关节置换术(aTSA)的肩关节。肩胛骨分层采用肱骨干固定技术:骨水泥或压合。收集术前和术后资料。主要结果测量包括活动范围、患者报告的结果和x线测量。结果:共纳入138例骨水泥肱骨柄和31例压合肱骨柄。所有aTSA患者的活动范围均有显著改善,最终骨水泥和压入式假体间无显著差异(前举:P=0.12,外旋:P=0.60,内旋:P=0.77)。患者报告的结果指标在最终随访中也显示出持续的改善。然而,在最后的随访中,与骨水泥组相比,加压支架组的总体评分明显更好(视觉模拟评分:P=0.04,美国肩关节外科医生评分:P)。结论:在本系列研究中,我们发现无论采用何种肱骨固定技术,aTSA均可显著改善肩关节功能。然而,在该队列中,就患者报告的结果评分而言,压合支架的效果明显好于骨水泥支架。证据水平:III。
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发文量
55
审稿时长
15 weeks
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