関節リウマチに対する第3世代全人工肩関節置換術と早期運動療法

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We have performed 3rd generation total shoulder arthroplasty (TSA) for rheumatoid arthritis (RA) shoulders of which cuff function was preserved since 2004. The aim of this study was to evaluate the short-term outcomes of the 3rd generation TSA. There were 10 RA shoulders that underwent TSA and were followed-up more than 1 year. All were women and the average age at surgery was 60 years old (range: 50 ∼ 71). The affected side was the right in 6 shoulders and the left in 4. The glenoid component was peg-type in 9 shoulders, and keel-type in 1 shoulder with a small glenoid. The humeral stem was inserted without bone cement in all shoulders but 1 revision case. The shoulder score of Japanese Orthopaedic Association (JOA score) and ROM were evaluated preoperatively and at the final follow-up. Subjective satisfaction was also evaluated. Presence of lucent line and loosening was determined in the A-P radiograph. The average follow-up period was 22.7 months (range: 14 ∼ 41). JOA score significantly improved from 40.1 (18 ∼ 54) preoperatively to 81.4 points (58.5 ∼ 95) postoperatively. The pain score improved from 5.0 to 24.4 points, and the function score from 3.9 to 8.5 points. The flexion angle improved from 82.0° (40° ∼ 130°) to 132.5° (105° ∼ 160°), and external rotation from17.5° (-10° ∼ 45°) to 43.0°(20° ∼ 80°). Subjective satisfaction was obtained in all cases. Lucent line around the glenoid component was observed in 1 shoulder, however, no progress was shown during the follow-up period; no loosening was observed. Compared to our previous result of the 2nd generation TSA, postoperative JOA score and pain score were comparable, whereas the 3rd generation obtained better flexion angle. When TSA is performed using 3rd generation prosthesis while the cuff function is preserved, not only pain relief but satisfying improvement of shoulder function can be expected.
日本肩関節学会の論文
2009-07-27

関節リウマチに対する第3世代全人工肩関節置換術と早期運動療法

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