抄録
The purpose of this study was to investigate the safety and clinical results of total shoulder arthroplasty (TSA) and humeral head replacement (HHR) with/without tendon muscle transfer for patients 75 years of age and older. In the case of cuff tear arthropathy, HHR with lattisimus dorsi transfer was performed when the primary repair of the torn cuff was impossible even if the smallest head component was used. Between 1998 and 2009, 13 TSA and 39 HHR in 47 patients were performed. Diagnoses of the patients were primary OA; 18cases, secondary OA; 3cases, chronic posterior dislocation; 3cases, and cuff tear arthropathy; 28cases. The average age of patients was 79 years old at the time of surgery (range; 75 ∼ 91). Previous health status, post operative medical and surgical complications were investigated. The 34 patients, followed more than 1 year after surgery, were evaluated and clinical outcome rated with modified Neer's classification and Japanese Orthopaedic Association shoulder scoring system (JOA score). There were no peri-operative deaths. Postoperative confusion occurred in 2 cases. Incomplete radial nerve palsy occurred in one case with lattisimus dorsi transfer. Intra operative fracture happened in 3 cases. There was one case of late MRSA infection at 3months after surgery. In cases of primary OA, the clinical results were satisfactory or better with 64.3% of patients. In cases of cuff tear arthropathy, the clinical results were satisfactory or better with 70.6% of patients. TSA and HHR are safe and effective treatment options even in elderly patients. However, the adequate release of contracted soft tissues is very important to prevent the intraoperative humeral fractures.
