Tipos de componentes glenoidais na artroplastia total anatômica do ombro: revisão sistemática
Data
2022-12-14
Autores
Zan, Renato Aroca 
Orientadores
Tamaoki, Marcel Jun Sugawara
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: a Artroplastia Total Anatômica do Ombro (ATO) é realizada nos pacientes portadores de osteoartrite da articulação do ombro em estágios mais graves ou na falha do tratamento conservador. Soltura do componente glenoidal representa um dos principais mecanismos de falha; contudo permanecem dúvidas quanto à seleção do melhor implante. Objetivo: avaliar a efetividade entre os implantes glenoidais exclusivos em polietileno (PE) e os implantes com metal back (MB). Métodos: revisão sistemática de ensaios clínicos randomizados (ECR), comparando os implantes de PE (keel e peg) com os de MB. Resultados: incluídos oito ECR, com 323 pacientes e 338 ombros, 151 homens, 157 mulheres, idade entre 60 e 74 anos e seguimento entre seis semanas a dez anos. Na comparação dos componentes em PE, o desfecho clínico por meio do escore de Constant – Murley, amplitude de movimento e dor por meio da Escala Visual Analógica, não mostraram diferença, porém, houve redução na formação de linhas de radioluscência (LRL) em torno de 50% para os graus até um ou dois e 12,4% nas complicações e revisões de cirurgia a favor do peg sobre o keel. Comparando com MB, houve 25% mais incidência de LRL ao redor dos PE, contudo a função e as taxas de complicações foram equivalentes. Conclusão: o componente em PE nas ATO, apresenta mais LRL comparado ao implante glenoidal em MB, em especial ao redor do modelo keel.
Introduction: Anatomical total shoulder arthroplasty is an effective treatment adopted for patients with glenohumeral osteoarthritis. Loosening of the glenoid component represents one of the main failure mechanisms; however, doubts remain regarding the selection of the best implant for avoiding complication. Objective: evaluate the effectiveness between exclusive polyethylene (PE) glenoid implants and metal back (MB) implants. Methods: systematic review of randomized clinical trials (RCTs), comparing PE (keeled and pegged) versus MB implants. Results: eight RCTs were included, with 323 patients and 338 shoulders, 151 men, 157 women, aged between 60 and 74 years with follow-up from six weeks to ten years. Shoulder function through the Constant-Murley score, range of motion and pain through the Visual Analogue Scale, were important outcomes to access the PE components that showed no difference; meanwhile, there was a reduction in radiolucency lines (RL) up to grade two around 50% and 12.4% for complications and surgery revisions in favor of the peg over the keel. Compared to MB, there was 25% more RL around PE, however function and complication rates were equivalent. Conclusion: the PE component in anatomical total shoulder arthroplasty, shows more RL compared to MB, especially around the keel design.
Introduction: Anatomical total shoulder arthroplasty is an effective treatment adopted for patients with glenohumeral osteoarthritis. Loosening of the glenoid component represents one of the main failure mechanisms; however, doubts remain regarding the selection of the best implant for avoiding complication. Objective: evaluate the effectiveness between exclusive polyethylene (PE) glenoid implants and metal back (MB) implants. Methods: systematic review of randomized clinical trials (RCTs), comparing PE (keeled and pegged) versus MB implants. Results: eight RCTs were included, with 323 patients and 338 shoulders, 151 men, 157 women, aged between 60 and 74 years with follow-up from six weeks to ten years. Shoulder function through the Constant-Murley score, range of motion and pain through the Visual Analogue Scale, were important outcomes to access the PE components that showed no difference; meanwhile, there was a reduction in radiolucency lines (RL) up to grade two around 50% and 12.4% for complications and surgery revisions in favor of the peg over the keel. Compared to MB, there was 25% more RL around PE, however function and complication rates were equivalent. Conclusion: the PE component in anatomical total shoulder arthroplasty, shows more RL compared to MB, especially around the keel design.