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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Survivorship after Arthroscopic Management of Glenohumeral Osteoarthritis with a Minimum 5 year Follow-up
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Survivorship after Arthroscopic Management of Glenohumeral Osteoarthritis with a Minimum 5 year Follow-up

机译：关节镜处理Glenohumeral骨关节炎后的生存期，至少5年随访

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Objectives: We previously reported clinical improvement and pain relief following arthroscopic management of glenohumeral osteoarthritis (GHOA) at 2 years. The purpose of this study was to determine 5 year survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA. Methods: This study had prior IRB approval. The CAM procedure was performed on a consecutive series of 42 young patients (44 shoulders) with GHOA who otherwise met criteria for shoulder arthroplasty but instead opted for joint preservation. The procedure included glenohumeral chondroplasty, capsular release, and synovectomy, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, loose body removal, microfracture and biceps tenodesis. Only patients who were a minimum of 5 years out from surgery were included in the study. Patients completed a subjective questionnaire, and further surgical intervention of the index shoulder was noted for survivorship analysis. Failure was defined as progression to TSA. Kaplan Meier survivorship analysis was performed. Results: Forty-two patients (with 44 shoulders) underwent a CAM procedure between 1/2006-12/2009 and were included. All patients were self-described recreational athletes. Seven patients were former collegiate or professional athletes. Mean follow-up was 5.9 years (range, 5 years to 8.1 years). Mean age at surgery was 52 (range 27- 68) years old in 13 women and 29 men. Eleven shoulders (26%) failed and progressed to TSA at a mean of 2.9 years (1.0-5.4 years). Shoulder status (progression to TSA or not) at minimum 5 years (range 5.3 - 9.4 years) was known for 95% (42/44). One patient progressed to another surgery for stiffness at a mean of 5.6 months and another patient underwent a revision CAM procedure at 7.9 years. From this cohort, Kaplan Meier survivorship was 92% at 1 year, 85.7% at 3 years, and 75.3% survivorship at 5 years. Conclusion: The long term durability of arthroscopic management for symptomatic GHOA is not well studied. Glenohumeral debridement and capsular release may not be enough to address all the pain generating pathology in the osteoarthritic shoulder. After the CAM procedure we found an 84% survivorship at 3 years and 72% survivorship at 5 years. Predictors of success were not known in the early years for this patient cohort. We have since found that factors such as joint space > 2 mm, glenoid morphology (A1, A2, B1) and CSA > 30o are associated with better outcomes. The 72% survivorship at 5 years demonstrated in this study can serve as a benchmark. Hopefully, with better patient selection, excluding those with negative predictive factors, outcomes and survivorship after the CAM procedure for GHOA can be improved.
机译：目的：我们先前报道了在关节镜下治疗肱肱骨骨关节炎（GHOA）2年后的临床改善和疼痛缓解。这项研究的目的是确定综合关节镜处理（CAM）程序治疗GHOA的5年生存率。方法：本研究已获得IRB事先批准。对连续的42例GHOA的年轻患者（44个肩膀）进行了CAM手术，这些患者原本符合肩关节置换的标准，但选择保留关节。该程序包括肱肱软骨成形术，囊膜释放和滑膜切除术，肱骨成形术，腋神经神经溶解，肩峰下减压，松动的身体去除，微骨折和二头肌腱切术。该研究仅包括距离手术至少5年的患者。患者完成了主观调查问卷，并注意到对食指肩部进行了进一步的手术干预以进行生存分析。失败被定义为发展为TSA。进行了Kaplan Meier生存分析。结果：42名患者（44肩）在1 / 2006-12 / 2009期间接受了CAM手术，包括在内。所有患者均为自我描述的休闲运动员。七名患者是前大学或专业运动员。平均随访时间为5.9年（范围从5年到8.1年）。 13名女性和29名男性的平均手术年龄为52岁（27-68岁）。 11个肩膀（占26％）失败，平均发展2.9年（1.0-5.4年）发展为TSA。已知至少5年（范围为5.3-9.4年）的肩膀状况（是否进展为TSA）占95％（42/44）。一名患者平均需要5.6个月进行另一次僵硬手术，而另一名患者在7.9年接受了CAM修订手术。在该队列中，Kaplan Meier的1年生存率为92％，3年为85.7％，而5年生存率为75.3％。结论：对有症状的GHOA的关节镜处理的长期耐久性尚无很好的研究。 Glenohumeral清创术和包膜释放可能不足以解决骨关节炎肩部所有引起疼痛的病理情况。进行CAM程序后，我们发现3年生存率达到84％，5年生存率达到72％。在这一患者队列的早期，尚不清楚成功的预测因素。从那以后，我们发现诸如关节间隙> 2 mm，关节盂形态（A1，A2，B1）和CSA> 30o等因素与较好的预后相关。这项研究表明，在5年时72％的存活率可以作为基准。希望通过更好的患者选择，排除那些具有负面预测因素的患者，可以改善CAM手术后GHOA的预后和生存率。

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