Shoulder Arthroplasty Outcomes After Prior Non-Arthroplasty Shoulder Surgery
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Résumé
BACKGROUND: The purpose of this retrospective study was to compare outcomes and complications in patients with and patients without a history of non-arthroplasty surgery on the ipsilateral shoulder who later underwent total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). We hypothesized that patients who had undergone prior surgery would have more complications and worse clinical outcomes. METHODS: Consecutive patients who had undergone shoulder arthroplasty and had been followed for a minimum of 2 years were evaluated with the American Shoulder and Elbow Society scoring system (ASES), Simple Shoulder Test (SST), and Visual Analog Scale (VAS) assessments and with physical examination, including range-of motion assessments. Complications and outcomes in patients who had undergone prior surgery on the ipsilateral shoulder (PS group) were compared with those in patients without such a history (NPS group). RESULTS: Data on 506 shoulder arthroplasties (263 TSA and 243 RTSA) were available for analysis. A total of 144 patients (28%) had an average of 1.9 ± 1.0 surgical procedures on the ipsilateral shoulder before arthroplasty. The average age in the PS group was significantly younger at the time of arthroplasty compared with the NPS group (61.6 ± 10.2 years compared with 68.2 ± 8.6 years, p = 0.035). At an average follow-up of 42.8 ± 16.4 months, both groups had significant improvements in ASES, SST, VAS, and range-of-motion values (p < 0.05 for all). All outcome scores in the PS group were significantly lower than those in the NPS group (p < 0.001 for all). The PS group also had a significantly higher complication rate than the NPS group (19.4% compared with 4.4%, p < 0.001), and multivariate regression analysis revealed that prior surgery was a significant independent predictor of postoperative complications. There were no differences between the PS and NPS groups in the number of postoperative infections (p = 0.679), reoperations (p = 0.553), or transfusions (p = 0.220). CONCLUSIONS: Patients who have a history of prior surgery on the ipsilateral shoulder derive benefit from shoulder arthroplasty, but their magnitude of improvement and final scores are lower than those of patients who do not have such a history. This information can be used to counsel this challenging patient population on expected outcomes following shoulder arthroplasty. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle