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Clinical and radiographic findings in bilateral total shoulder arthroplasty

Klinische Ergebnisse und Röntgenbefunde bei beidseitiger Totalendoprothese der Schulter

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Abstract

Hypothesis

We hypothesized that the clinical and functional results as well as the absence or presence of radiolucent lines may be more affected by patient-related (internal) factors than by nonpatient-related factors (external factors). To test this hypothesis, we compared the clinical and radiological results of patients who underwent bilateral total shoulder arthroplasty in an individual matched-pair analysis.

Methods

We evaluated 47 patients who underwent two-staged bilateral primary shoulder arthroplasty with a cemented glenoid component. The Constant score as well as radiography in two plains were examined before surgery and at most recent follow-up.

Results

The mean Constant score for all shoulders increased from 24 (range 0–55) points to 64.8 (range 10–84) points at a mean of 46.4 (range 24–178) months. There was no significant difference for the clinical outcome, range of motion, radiolucent lines, or tilting of the glenoid component between the two sides of the body. A significant difference was found for superior subluxation with higher results for the first arthroplasty. We found in 92 % of all cases radiolucent lines grade 2 or higher according to Franklin and in 23 % moderate or severe superior subluxation. These radiographic findings develop constantly over time. Superior subluxation and tilting of the glenoid component influenced the postoperative Constant score (p = 0.010; p = 0.044), while radiolucent lines had no impact on clinical outcome (p = 0.798).

Conclusion

Primary staged bilateral TSA can provide good results in patients with osteoarthritis of the shoulder. Our findings demonstrated that internal factors as well as external factors influence the clinical and radiological results in TSA.

Zusammenfassung

Hypothese

Die Hypothese lautete, dass patientenbezogene (innere) Faktoren die klinischen und funktionellen Ergebnisse wie auch das Vorhandensein oder Fehlen von röntgenhellen Linien stärker beeinflussen können als nicht-patientenbezogene (äußere) Faktoren. Zur Prüfung der Hypothese wurden die klinischen und radiologischen Ergebnisse von Patienten, die eine beidseitige Totalendoprothese (TEP) der Schulter erhielten, in einer individuellen Matched-pair-Analyse verglichen.

Methoden

Wir analysierten 47 Patienten, die in zwei Schritten eine beidseitige primäre TEP der Schulter mit zementierter Glenoidkomponente erhielten. Betrachtet wurden der Constant-Score sowie Röntgenaufnahmen in zwei Ebenen vor dem chirurgischen Eingriff und in der letzten Nachuntersuchung.

Ergebnisse

Der durchschnittliche Constant-Score aller Schultern erhöhte sich von 24 (0–55) Punkte auf 64,8 (10–84) Punkte innerhalb von durchschnittlich 46,4 (24–178) Monaten. Zwischen den beiden Körperhälften bestand kein signifikanter Unterschied im klinischen Ergebnis, dem Bewegungsumfang, den Aufhellungslinien oder der Verkippung der Glenoidkomponente. Ein signifikanter Unterschied fand sich bezüglich der superioren Subluxation mit höheren Werten bei Erstendoprothese. In 92 % der Fälle lagen Aufhellungslinien von Grad 2 oder höher nach Franklin vor, in 23 % eine mäßige oder schwere superiore Subluxation. Diese Röntgenbefunde nahmen im Zeitverlauf eine konstante Entwicklung. Die superiore Subluxation und die Verkippung der Glenoidkomponente beeinflussten den postoperativen Constant-Score (p = 0,010; p = 0,044). Die Aufhellungslinien zeigten dagegen keinen Effekt auf das klinische Ergebnis (p = 0,798).

Schlussfolgerungen

Mit der primären beidseitigen Schulter TEP lassen sich bei Patienten mit Schultergelenkarthrose gute Resultate erzielen. Unsere Studie belegt, dass innere wie auch äußere Faktoren Einfluss auf die klinischen und radiologischen Ergebnisse der Schulter-TEP nehmen.

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Authors and Affiliations

  1. Zentrum für Orthopädie und Unfallchirurgie, Universität Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    Guido Pape, Felix Zeifang &  Patric Raiss

  2. ATOS Klinik Heidelberg, Bismarckstrasse 9–15, 69115, Heidelberg, Germany

    Markus Loew

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  1. Guido Pape
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Correspondence to Patric Raiss.

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G. Pape, M. Loew, F. Zeifang and P. Raiss states that there are no conflicts of interest.

The study was approved by the local ethical board and was in accordance with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.

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Pape, G., Loew, M., Zeifang, F. et al. Clinical and radiographic findings in bilateral total shoulder arthroplasty. Obere Extremität 10, 101–106 (2015). https://doi.org/10.1007/s11678-015-0312-6

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