当科における人工肩関節置換術の治療成績の検討

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  • Clinical Results of Total Shoulder Arthroplasty for Osteoarthritis and Rheumatoid Arthritis
  • トウ カ ニ オケル ジンコウ カタカンセツ チカンジュツ ノ チリョウ セイセキ ノ ケントウ

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Objective: To investigate the clinical and radiographic results of total shoulder arthroplasty (TSA) for damaged shoulder joints with osteoarthritis (OA) and rheumatoid arthritis (RA).<br>Patients and Methods: From 1999 to 2012 inclusive, we performed 19 total shoulder arthroplasties in 17 patients. A total of sixteen shoulders, five with OA and 11 with RA, from 15 patients were followed up for more than six months. All patients were female, with an average age of 71 years, and an average follow-up period of three years. Preoperative magnetic resonance imaging showed that the supraspinatus tendon was intact in five shoulders (intact group), and torn or thin in 11 shoulders (damaged group), respectively. Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) score, Disabilities of the Arm, Shoulder and Hand (DASH) score and range of motion (ROM). Radiographic loosening of the humeral stem and glenoid component was evaluated according to the criteria described by Stewart.<br>Results: The average JOA score improved from 39.9 points preoperatively to 80.3 points at the final follow-up. The average DASH score improved from 70.1 points to 56.0 points. The range of active flexion, abduction and external rotation significantly improved postoperatively. Radiolucent line evaluation around the glenoid component was observed in two shoulders. There was no significant difference in the improvement of the JOA score between the intact group and the damaged group. In both groups, pain relief was experienced postoperatively, but the improvement in ROM consisting of flexion, abduction and external rotation, was significantly greater in the intact group than in the damaged group. The postoperative JOA score showed a strong inverse correlation with the preoperative DASH score.<br>Conclusion: The results of the current study showed satisfactory clinical outcomes of TSA for OA and RA, particularly with the treatment effect of good postoperative pain relief. Clinical outcome may depend on the preoperative status of the rotator cuff and the function of the upper extremity.

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