Background: 

Glenoid component failure is a major concern after anatomic total shoulder arthroplasty (aTSA). Ream and run (RnR) is an alternative procedure that may avoid glenoid-related complications. The purpose of this study was to compare outcomes of RnR versus aTSA in younger patients with advanced glenohumeral osteoarthritis.

Methods: 

This was a retrospective matched-cohort study of 110 patients who underwent aTSA and 57 patients who underwent RnR; patients were <66 years of age and had a minimum of 2 years of follow-up. Propensity matching was performed using 21 preoperative variables. Pre- and postoperative patient-reported outcome measures (PROMs) and health-related quality-of-life (HRQoL) scores, satisfaction with outcome, and revision data were analyzed. Mixed-effects models examined the association of preoperative variables with outcomes.

Results: 

Thirty-nine patient pairs were matched. All patients were male, with a mean age of 58.6 ± 7.3 years and a mean follow-up 4.4 ± 2.3 years. The aTSA cohort had better final Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) scores. However, in the mixed-effects model analysis, arthroplasty type was not associated with outcome. At 2 years postoperatively, a significantly greater percentage of aTSA patients achieved the substantial clinical benefit (SCB) for the ASES (100% versus 79.2%; p = 0.01) and the minimal clinically important difference (MCID) (89.7% versus 75%; p = 0.02) for the visual analog scale (VAS) for pain. At >5-year follow-up, there were no significant differences between the cohorts in the percentage who achieved the MCID, SCB, or patient acceptable symptom state (PASS) for the ASES, SST, and VAS for pain. Three patients underwent revision arthroplasty for pain after RnR, at a mean of 1.9 ± 1.7 years. Two patients underwent revision arthroplasty for glenoid loosening at 9.2 and 14 years after aTSA.

Conclusions: 

RnR and aTSA had comparable outcomes in most analyses. The greater early revision rate after RnR should focus attention on optimizing patient selection and postoperative management. Revision for glenoid loosening is a concern among younger and active patients. Longer-term study is needed to better understand the relative benefits and disadvantages of these procedures.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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肱骨头置换术与关节盂扩孔关节成形术（扩孔和运行）与解剖全肩关节置换术的比较：一项匹配队列研究

背景： 

关节盂组件失效是解剖型全肩关节置换术 (aTSA) 后的一个主要问题。扩孔和运行 (RnR) 是一种替代手术，可以避免关节盂相关并发症。本研究的目的是比较 RnR 与 aTSA 在患有晚期盂肱骨关节炎的年轻患者中的结果。

方法： 

这是一项回顾性匹配队列研究，纳入了 110 名接受 aTSA 的患者和 57 名接受 RnR 的患者；患者年龄<66岁并且至少进行了2年的随访。使用 21 个术前变量进行倾向匹配。分析了术前和术后患者报告的结果测量（PROM）和健康相关的生活质量（HRQoL）评分、结果满意度和修订数据。混合效应模型检查了术前变量与结果的关联。

结果： 

匹配了三十九对患者。所有患者均为男性，平均年龄 58.6 ± 7.3 岁，平均随访时间 4.4 ± 2.3 年。aTSA 队列的最终简单肩部测试 (SST) 和美国肩肘外科医生 (ASES) 分数更高。然而，在混合效应模型分析中，关节置换术类型与结果无关。术后 2 年，aTSA 患者中达到 ASES 显着临床获益 (SCB)（100% 对比 79.2%；p = 0.01）和最小临床重要差异 (MCID)（89.7% 对比 75%；p = 0.01）的比例显着增加。 p = 0.02) 疼痛视觉模拟量表 (VAS)。在超过 5 年的随访中，各队列之间达到 MCID、SCB 或 ASES、SST 和疼痛 VAS 的患者可接受症状状态 (PASS) 的百分比没有显着差异。3 名患者在 RnR 后因疼痛而接受翻修关节置换术，平均时间为 1.9 ± 1.7 年。两名患者在 aTSA 术后 9.2 和 14 年因关节盂松动接受了翻修关节成形术。

结论： 

在大多数分析中，RnR 和 aTSA 的结果相当。RnR 术后早期翻修率较高，应重点关注优化患者选择和术后管理。关节盂松动的修复是年轻且活跃的患者所关心的问题。需要更长期的研究来更好地了解这些手术的相对优点和缺点。

证据级别： 

治疗三级。有关证据级别的完整描述，请参阅作者须知。