ABSTRACT
BACKGROUND: The primary objective of this study was to evaluate and compare the incidence of complications and revision surgeries between in two of convertible metal-back glenoid systems in total shoulder arthroplasty (aTSA) groups over a follow-up period of up to five years. METHODS: A retrospective analysis included 69 shoulders from 65 patients with primary aTSA. Patients were divided into Group 1 (n=31), receiving convertible cementless stemmed aTSA (Lima SMR) and Group 2 (n=38), receiving humeral head replacement aTSA (Arthrex, Eclipse) both with metal-back glenoid components. Clinical and radiological assessments were conducted at 2, 5, and 10 years postoperatively. Assessments included the following: Constant Score, DASH, SPADI, SSV, Glenohumeral Distance, Critical Shoulder Angle and Lateral Acromion Index. In addition, we compared complications, revision rates and survival rates between groups using Kaplan-Maier curves and Log-Rank-test. RESULTS: Baseline demographics and preoperative outcome scores showed no significant differences between groups (p≥0.05). The overall revision rate did not significantly differ between groups (Group 1:32% vs. Group 2:24%, p=0.60), nor did the mean time to revision (p=0.27). The mean follow-up was 71±41 months (Group 1: 94±48 months, Group 2: 53±23 months, p<0.001). Kaplan-Meier analysis showed similar mid-term survival probabilities (p=0.94). Revision reasons included rotator cuff insufficiency (n=4 in Group 1, n=2 in Group 2) and glenoid wear/loosening (n=5 in Group 1, n=7 in Group 2). Interestingly, Group 1 demonstrated no occurrence of glenoid metal baseplate or humeral loosening, while complex revisions were more common in the Group 2. At 2 and 5 years, non-revised patients in both groups had similar outcome scores. CONCLUSION: Metal-backed glenoid implants in combination with both stemless and stemmed humeral components in aTSA exhibit comparable revision rates and survival probabilities. Rotator cuff insufficiency and polyethylene wear are the two most common complications leading to revision. To facilitate ongoing monitoring and optimize patient safety, we implemented a modification in the follow-up protocol, transitioning to annual appointments or earlier when necessary. This study underscores the unsolved disadvantages in metal-back components and the importance of a mid- to long-term longitudinal assessment of those patients.
ABSTRACT
INTRODUCTION: The optimal treatment strategy for the proximal humeral fracture (PHF) remains controversial. The debate is centered around the correct treatment strategy in the elderly patient population. The present study investigated whether age predicts the functional outcome of locking plate osteosynthesis for this fracture entity. METHODS: A consecutive series of patients with surgically treated displaced PHF between 01/2017 and 01/2018 was retrospectively analyzed. Patients were treated by locking plate osteosynthesis. The cohort was divided into two groups: Group 1 (≥65 years) and Group 2 (<65 years). At the follow-up examination, the SSV, CMS, ASES, and Oxford Shoulder Score (OS), as well as a radiological follow-up, was obtained. The quality of fracture reduction is evaluated according to Schnetzke et al. Results: Of the 95 patients, 79 were followed up (83.1%). Group 1 consists of 42 patients (age range: 65-89 years, FU: 25 months) and Group 2 of 37 patients (28-64 years, FU: 24 months). The clinical results showed no significant differences between both groups: SSV 73.4 ± 23.4% (Group 1) vs. 80.5 ± 189% (Group 2). CMS: 79.4 ± 21 vs. 81.9 ± 16, ASES: 77.2 ± 20.4 vs. 77.5 ± 23.1, OS: 39.5 ± 9.1 vs. 40.8 ± 8.2; OS: 39.5 ± 9.1 vs. 40.8 ± 8.2. In the radiological follow-up, fractures healed in all cases. Furthermore, the quality of fracture reduction in both groups is comparable without significant differences. The revision rate was 9.5% in Group 1 vs. 16.2% in Group 2. DISCUSSION: Both age groups show comparable functional outcomes and complication rates. Thus, the locking plate osteosynthesis can be used irrespective of patient age; the treatment decision should instead be based on fracture morphology and individual patient factors.
