COMPARISON OF CLINICAL OUTCOMES WITH POSTERIORLY AUGMENTED GLENOID COMPONENTS WITH ANATOMIC AND REVERSE TOTAL SHOULDER ARTHROPLASTY

摘要

Introduction: This study quantifies outcomes achieved using posteriorly augmented aTSA and rTSA glenoid implants in patients with severe posterior wear. Methods: 168 patients (mean 69.0yrs) with 2 yrs min followup were treated by 8 surgeons using either 8A° posteriorly augmented aTSA/rTSA glenoid components in patients with severe posterior wear. 83 aTSA patients received 8A° posteriorly augmented glenoids (mean 66.1 yrs; 33F/5OM) for OA and 85 rTSA patients received 8A° posteriorly augmented glenoids (mean 71.8 yrs; 37F/48M) for treatment of CTA. Outcomes were scored using SST, UCLA, ASES, Constant, and SPADI metrics; abduction, forward flexion, internal rotation score, and external rotation were also measured. Average follow-up was 35.3 months (aTSA 37.4; rTSA 33.2). A two-tailed, unpaired t-test identified differences (p<0.05) in pre-operative, post-operative, and improvements. Results: Posterior augment aTSA and rTSA reliably provided pain relief and function with 96.3% of aTSA and 94.0% of rTSA patients rating themselves as being much better or better prior to treatment. Postoperatively, aTSA patients had significantly better average SST (p = 0.0111) and SPADI (p = 0.0146) scores and significantly more IR (p < 0.0001), active external rotation (p < 0.0001), and passive external rotation (p <0.0001) than rTSA patients with posterior glenoid wear. 27.8% of augmented aTSA patients had radiolucent glenoid lines (11 grade 1, 1grade 2, 1 grade 3, and 1 grade 5). 4.6% of rTSA patients had scapular notching (3 grade 1). 8 complications (0 glenoid loosening) occurred for both cohorts with a similar rate (p = 0.9727): aTSA patients had 4 complications (4.8%) and rTSA patients had 4 complications (4.7%). Conclusions: These results demonstrate good short term outcomes can be achieved in patients with severe posterior wear using posteriorly augmented aTSA/rTSA glenoid implants. Longer-term follow-up is needed to confirm these positive outcomes.