Meta-analysis of total shoulder arthroplasty with stemmed prosthesis versus stemless prosthesis for treating shoulder osteoarthritis

doi:10.3969/j.issn.2095-4344.1195

Abstract

Abstract:

BACKGROUND: The clinical effects of total shoulder arthroplasty in the treatment of shoulder osteoarthritis is remarkable, and some controlled studies aim at confirming the clinical effects of stemmed and stemless prostheses for treating shoulder osteoarthritis, but the results need to be investigated further.

OBJECTIVE: To systematically evaluate the effects of the clinical outcomes of stemmed versus stemless total shoulder arthroplasty in the treatment of shoulder osteoarthritis.

METHODS: Databases of PubMed, SpringerLink, Web of Science, EBSCO, The Cochrane Library, EMBASE, CNKI, WanFang and VIP for the randomized controlled trials and non-randomized controlled trials of stemmed versus stemless total shoulder arthroplasty in the treatment of shoulder osteoarthritis published before September 2018. The methodological quality of the included studies was evaluated. Meta-analysis was conducted on RevMan 5.3 software that the Cochrane Collaboration provided to compare the differences of effectiveness between stemmed and stemless total shoulder arthroplasty in the treatment of shoulder osteoarthritis.

RESULTS AND CONCLUSION: (1) A total of five studies were included, including three randomized controlled studies and two non-randomized clinical controlled studies, with a total of 182 patients, and 190 shoulders (this study was analyzed by shoulder count). (2) Meta-analysis results showed that the stemless prosthesis group had shorter operation time and less postoperative blood loss than the stemmed prosthesis group. (3) The postoperative Constant score in the stemless prosthesis group was lower than that in the stemmed prosthesis group. After excluding one low-quality literature by sensitivity analysis, there was no significant difference in the postoperative Constant score between two groups. (4) No significant difference was found in the activities of daily living scores, strength scores, pain scores, range of motion of shoulder joint, and shoulder flexion and abduction between two groups. (5) These results indicate that the short- and mid-term effects of stemmed versus stemless total shoulder arthroplasty in the treatment of shoulder osteoarthritis are comparable, but stemless total shoulder arthroplasty can shorten the average operation time and reduce the blood loss after surgery.

Key words: stemless, prosthesis, shoulder arthroplasty, osteoarthritis, randomized controlled, shoulder joint, stemmed prosthesis, shoulder flexion, shoulder abduction, meta-analysis

CLC Number:

R459.9

Wang Wei, Zhou Haonan, Zhang Yu, Wang Chenglong, Xie Chengxin, Yin Dong. Meta-analysis of total shoulder arthroplasty with stemmed prosthesis versus stemless prosthesis for treating shoulder osteoarthritis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(20): 3261-3267.

Figures/Tables 3

2.1 文献检索结果及质量评价根据检索策略，共检索到相关文献417篇，采用EndnoteX7排除重复文献后剩余332篇，然后经过读文题和摘要，排除重复、非临床研究及非治疗性文献308篇，初步筛选得到的24篇经过阅读全文，再次排除不符合纳入标准的文献19篇，最终获得纳入文献5篇[12-16]，其中3篇随机对照研究，2篇非随机对照试验，共计182例患者190肩。纳入研究的基本特征见表1，纳入文献质量评价及风险评价结果见图2。 2.2 Meta分析结果 2.2.1 术后Constant肩关节评分共有5篇文献报道了术后Constant评分[12-16]，共计190肩，其中无柄假体94肩，有柄假体96肩，异质性检验各研究间无明显异质性(I2=1%，P=0.40)，故采用固定效应模型。Meta分析结果显示，无柄假体组与有柄假体组的术后Constant评分比较差异有显著性意义[MD=-4.80，95%CI(-8.02，-1.58)，P=0.003]，无柄假体组术后Constant评分低于有柄假体组，见图3。敏感性分析结果显示，剔除1篇质量较低的文献[16]，结果发生改变[MD=-2.07，95%CI(-6.39，2.25)，P=0.35]，提示Meta分析稳定性比较差，尚不能认为2组术后Constant评分差异有显著性意义。 2.2.2 术后日常生活活动能力评分共有4篇文献报道了术后日常生活活动能力评分[13-16]，异质性检验提示，各研究间无明显异质性(I2=0%，P=0.56)，故采用固定效应模型。Meta分析结果显示，2组术后日常生活活动能力评分比较差异无显著性意义[MD=0.57, 95%CI(-0.24，1.38)，P= 0.17]，见图4。 2.2.3 术后疼痛评分共有4篇文献报道了术后疼痛评分[13-16]，异质性检验提示，各研究间存在明显异质性(I2=51%，P=0.10)，故采用随机效应模型。Meta分析结果显示，2组术后疼痛评分比较差异无显著性意义[MD= -0.55，95%CI(-2.05，0.95)，P=0.47]，见图5。"

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