Evolución clínico-radiológica de las prótesis invertidas de hombro

Abstract

Introduction. The performance of shoulder arthroplasty has undergone significant growth in last decades, especially due to the increase in the performance of reversed total shoulder arthroplasty (RTSA). Due to its increasingly widespread use, it is necessary to know what sociopersonal, clinical, radiological and surgical factors make it possible to predict and avoid post-surgical complications, as well as to improve the functional results of patients treated with RTSA. Objetives. The objectives are: 1.-To determine the sociopersonal, clinical and surgical factors that influence the development of post-surgical complications that occur in patients treated with RTSA; 2.-To assess the functional and radiological results of patients treated with RTSA; 3.-To analyze the influence of sociopersonal, clinical and surgical factors on the functional and radiological results of patients treated with RTSA. Patients and method. The study population is made up of patients with glenohumeral pathology treated with RTSA. Patients with glenohumeral pathology treated with RTSA are included with the following indications: rotator cuff arthropathy, massive and irreparable rotator cuff tear without osteoarthritis, humerus fracture, fracture sequelae, chronic locked glenohumeral dislocation, chronic pseudoparalysis, primary osteoarthritis, rheumatoid arthritis, review of anatomical shoulder prostheses and avascular necrosis of the humeral head. These variables are analyzed: socio-personal (age, sex), clinic (body mass index, comorbidity, surgical risk, dominant limb, laterality, dislocations, arthroscopy and previous open surgeries), surgical (surgical indication, approach, type of prosthesis, diameter of the glenoid baseplate, central post, screw size, diameter and orientation of the glenosphere, metal augmentation, glenoid graft, type and thickness of the insert, diameter of the humeral metaphysis, cemented prosthesis, complications), radiological (notching, scapular spur, ossifications in the glenohumeral space, resorption of the greater and lesser tuberosities of the humerus, stress zones, prosthetis-scapular neck angle, peg-glenoid rim distance, glenoid inclination, acromion-greater tuberosity distance, glena-greater tuberosity distance), functional results (pain, Constant-Murley test, DASH questionnaire). Results. N = 98 patients fulfill the selection criteria. In patients who presented post-surgical complications (n=10), a higher percentage of Delta Xtend TM prosthis (60% vs. 25%; p=0,030) was shown, as well as a higher percentage of some of its components: Delta glenosphere 38 mm (50% vs. 11,4%; p=0.005) and size of the humeral metaphysis Epiphysis 1 Delta (50% vs. 11,4%; p=0,007). Patients with a greater frequency of scapular notching had an absence of scapular spur (44,5% vs. 75%; p=0,002), greater prosthesis-scapular neck angle (84,4±14.6 ° vs. 97,9±21,6º; p=0.001), lower inclination of the glenoid (13,8±10,5º vs. 7,7±10,4º; p=0.005), lower acromion-greater tuberosity distance (48,4±10,7 mm vs. 42,4±12,1; p=0.048) and lower glena-greater tuberosity distance (42.9±6.1 mm vs. 38,4±6,2 mm; p=0.001). Patients with glenoid graft had less postoperative pain (1,6±2 vs. 0,7±0,9; p = 0,013). Patients with worse result in the Constant-Murley test were those with higher score in the "American Society of Anesthesiologists" classification (I: 74,4±3,9 vs. II: 70±11,6 vs. III: 62,9±14,5; p=0,001) and higher frequency of post-surgical complications (68,9±12,3 vs. 59,3±13,7; p = 0,023). Conclusions. Delta Xtend TM prosthesis is associated with a greater number of post-surgical complications, although this may have been due to the learning curve. The absence of a scapular spur, the greater prosthesis-scapular neck angle, the lower caudal inclination of the glenosphere, the lower acromion-tuberosity distance and the smaller glena-tuberosity distance are factors associated with a greater frequency of scapular notching. Bone graft is a factor associated with less postoperative pain. A higher number of post-surgical complications and a higher score in the "American Society of Anesthesiologists" classification are factors associated with a worse result in the Constant-Murley test.