Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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Does humeral fixation technique affect long-term outcomes of total shoulder arthroplasty?

  • Troy Li (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Kenneth H. Levy (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Akiro H. Duey (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Akshar V. Patel (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Christopher A. White (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Carl M. Cirino (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Alexis Williams (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Kathryn Whitelaw (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Dave Shukla (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Bradford O. Parsons (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Evan L. Flatow (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Paul J. Cagle (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai)
  • 투고 : 2023.03.09
  • 심사 : 2023.05.12
  • 발행 : 2023.09.01
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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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참고문헌

  1. Neer CS 2nd. Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am 1974;56:1-13. https://doi.org/10.2106/00004623-197456010-00001
  2. Litchfield RB, McKee MD, Balyk R, et al. Cemented versus un-cemented ixation of humeral components in total shoulder arthroplasty for osteoarthritis of the shoulder: a prospective, randomized, double-blind clinical trial-A JOINTs Canada Project. J Shoulder Elbow Surg 2011;20:529-36. https://doi.org/10.1016/j.jse.2011.01.041
  3. Werthel JD, Lonjon G, Jo S, Cofield R, Sperling JW, Elhassan BT. Long-term outcomes of cemented versus cementless humeral components in arthroplasty of the shoulder: a propensity score-matched analysis. Bone Joint J 2017;99:666-73. https://doi.org/10.1302/0301-620X.99B5.BJJ-2016-0910.R1
  4. Rahmi H, Jawa A. Management of complications after revision shoulder arthroplasty. Curr Rev Musculoskelet Med 2015;8:98-106. https://doi.org/10.1007/s12178-014-9249-4
  5. Nagels J, Stokdijk M, Rozing PM. Stress shielding and bone resorption in shoulder arthroplasty. J Shoulder Elbow Surg 2003;12:35-9. https://doi.org/10.1067/mse.2003.22
  6. Sanchez-Sotelo J, Wright TW, O'Driscoll SW, Cofield RH, Rowland CM. Radiographic assessment of uncemented humeral components in total shoulder arthroplasty. J Arthroplasty 2001;16:180-7. https://doi.org/10.1054/arth.2001.20905
  7. Verborgt O, El-Abiad R, Gazielly DF. Long-term results of un-cemented humeral components in shoulder arthroplasty. J Shoulder Elbow Surg 2007;16(3 Suppl):S13-8. https://doi.org/10.1016/j.jse.2006.02.003
  8. Patel AV, Patel MS, White CA, et al. Uncemented humeral stems in reverse total shoulder arthroplasty: a systematic review. Semin Arthroplasty 2022;32:367-74. https://doi.org/10.1053/j.sart.2021.11.010
  9. Rugg CM, Coughlan MJ, Lansdown DA. Reverse total shoulder arthroplasty: biomechanics and indications. Curr Rev Musculoskelet Med 2019;12:542-53. https://doi.org/10.1007/s12178-019-09586-y
  10. Singh JA, Sperling JW, Cofield RH. Revision surgery following total shoulder arthroplasty: analysis of 2588 shoulders over three decades (1976 to 2008). J Bone Joint Surg Br 2011;93:1513-7. https://doi.org/10.1302/0301-620X.93B11.26938
  11. Amroodi MN, Behshad V, Motaghi P. Long-term results, functional outcomes and complications after open reduction and internal fixation of neglected and displaced greater tuberosity of humerus fractures. Arch Bone Jt Surg 2016;4:330-6.
  12. Simovitch R, Flurin PH, Wright T, Zuckerman JD, Roche CP. Quantifying success after total shoulder arthroplasty: the minimal clinically important difference. J Shoulder Elbow Surg 2018;27:298-305. https://doi.org/10.1016/j.jse.2017.09.013
  13. Werner BC, Chang B, Nguyen JT, Dines DM, Gulotta LV. What change in American shoulder and elbow surgeons score represents a clinically important change after shoulder arthroplasty. Clin Orthop Relat Res 2016;474:2672-81. https://doi.org/10.1007/s11999-016-4968-z
  14. Lehtinen JT, Belt EA, Lyback CO, et al. Subacromial space in the rheumatoid shoulder: a radiographic 15-year follow-up study of 148 shoulders. J Shoulder Elbow Surg 2000;9:183-7. https://doi.org/10.1067/mse.2000.105446
  15. Sanchez-Sotelo J, O'Driscoll SW, Torchia ME, Cofield RH, Rowland CM. Radiographic assessment of cemented humeral components in shoulder arthroplasty. J Shoulder Elbow Surg 2001;10:526-31. https://doi.org/10.1067/mse.2001.118482
  16. Uy M, Wang J, Horner NS, et al. Cemented humeral stem versus press-fit humeral stem in total shoulder arthroplasty: a systematic review and meta-analysis. Bone Joint J 2019;101:1107-14. https://doi.org/10.1302/0301-620X.101B9.BJJ-2018-1369.R1
  17. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S240-52. https://doi.org/10.1002/acr.20543
  18. Romeo AA, Thorsness RJ, Sumner SA, Gobezie R, Lederman ES, Denard PJ. Short-term clinical outcome of an anatomic short-stem humeral component in total shoulder arthroplasty. J Shoulder Elbow Surg 2018;27:70-4. https://doi.org/10.1016/j.jse.2017.05.026
  19. Grob A, Freislederer F, Marzel A, Audige L, Schwyzer HK, Scheibel M. Glenoid component loosening in anatomic total shoulder arthroplasty: association between radiological predictors and clinical parameters: an observational study. J Clin Med 2021;10:234.
  20. Cotton RE, Rideout DF. Tears of the humeral rotator cuff: a radiological and pathological necropsy survey. J Bone Joint Surg Br 1964;46:314-28. https://doi.org/10.1302/0301-620X.46B2.314
  21. Gruber G, Bernhardt GA, Clar H, Zacherl M, Glehr M, Wurnig C. Measurement of the acromiohumeral interval on standardized anteroposterior radiographs: a prospective study of observer variability. J Shoulder Elbow Surg 2010;19:10-3. https://doi.org/10.1016/j.jse.2009.04.010
  22. LaChaud GY, Schoch BS, Wright TW, et al. Humeral stem lucencies correlate with clinical outcomes in anatomic total shoulder arthroplasty. JSES Int 2020;4:669-74. https://doi.org/10.1016/j.jseint.2020.03.011