Comparative and predictive modeling of modern anatomic total shoulder arthroplasty revision rates in osteoarthritis with different polyethylene glenoid designs
David R.J. Gill MBChB, FRACS, FAOrthA , Sophia Corfield PhD (Hons) , Peiyao Du BBiostat , Dylan Harries BSc (Hons), PhD , Richard S. Page BMedSci, MBBS, FRACS, FAOrthA
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引用次数: 0
Abstract
Background
The revision rates of 4 modern (currently used) polyethylene glenoid designs in anatomic total shoulder arthroplasty (stemmed and stemless) for osteoarthritis (OA) are compared from a national arthroplasty registry to model predictive variables.
Materials and Methods
The study period was January 1, 2008, to December 31, 2023. The study population included all primary anatomic total shoulder arthroplasty (aTSA) procedures undertaken for OA. We classified the designs of modern polyethylene glenoids (glenoid component types) into 4 cohort groups: cemented all-polyethylene glenoids (CPGs), polyethylene glenoids with modified central pegs (MCPGs), nonmodular metal-backed glenoids (NMBGs), and hybrid glenoids (HGs). The cumulative percentage revision (CPR) was defined using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models adjusted for age, sex, humeral head size, humeral fixation, primary type (stemmed or stemless), and mean surgeon volume. Only prostheses with all known variables were analyzed. Possible interactions were examined. A subanalysis was undertaken capturing additional patient demographics from January 1, 2017.
Results
There were 9332 primary aTSA procedures. The CPR at 8 years for CPG (n = 5048) was 5.5% (95% confidence interval [CI] 4.6, 6.4), 3.8% (95% CI 2.9, 5.1) for MCPG (n = 2217), and 9.4% (95% CI 7.4, 11.9) for HG (n = 1658). The NMBG (n = 409) had a 2-year CPR of 4.7% (95% CI 2.1, 10.1). The glenoid component type (CPG, MCPG, NMBG, or HG) influenced the rate of revision of aTSA (P < .001). There is evidence for an interaction term between age and glenoid type (P = .009), with a better model (Akaike information criterion [AIC] 6205.9) than main effects only (AIC 6211.5). There was no difference at subanalysis, whereas the patient sex, type of primary, polyethylene type, American Society of Anesthesiologists class, body mass index, glenoid fixation, glenoid morphology, and mean surgeon volume were less predictive than glenoid component type alone.
Conclusion
Modern aTSA outcome for OA is affected by the polyethylene glenoid design implanted, with the result only modified further by patient’s age. Informed decision making about aTSA current prosthesis survival is more accurate if age of the patient is included.
背景：通过一项全国关节成形术登记，对解剖型全肩关节成形术（有柄和无柄）中四种现代（目前使用的）聚乙烯盂设计的骨关节炎（OA）翻修率进行比较，以建立预测变量模型：研究时间为2008年1月1日至2023年12月31日。研究对象包括所有因OA而进行的初级解剖型全肩关节置换术（aTSA）。我们将现代聚乙烯盂成形术（盂部件类型）的设计分为四组：全粘结聚乙烯盂成形术（CPG）、带改良中心钉的聚乙烯盂成形术（MCPG）、非模块化金属背衬盂成形术（NMBG）和混合盂成形术（HG）。使用Kaplan-Meier估计存活率和Cox比例危险模型中的危险比（HR）来定义累积翻修百分比（CPR），并对年龄、性别、肱骨头大小、肱骨固定、主要类型（有柄或无柄）和外科医生平均手术量进行调整。仅对所有已知变量的假体进行了分析。对可能存在的相互作用进行了研究。从2017年1月1日起，还进行了一项子分析，以获取更多的患者人口统计数据：共进行了 9332 例初级 aTSA 手术。CPG（n=5,048）8年的CPR为5.5%（95%置信区间（CI）4.6，6.4），MCPG（n=2,217）为3.8%（95% CI 2.9，5.1），HG（n=1,658）为9.4%（95% CI 7.4，11.9）。NMBG（人数=409）的2年CPR为4.7%（95% CI为2.1，10.1）。髋臼组件类型（CPG、MCPG、NMBG、HG）影响了aTSA的翻修率（p结论：现代人工全髋关节置换术治疗 OA 的结果受植入的聚乙烯髋关节盂设计的影响，只有患者的年龄会进一步改变结果。如果将患者的年龄也包括在内，那么有关当前 aTSA 假体存活率的知情决策就会更加准确。
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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