解剖学和反转型肩关节置换术（aTSA，rTSA）已经成为治疗原发性骨关节炎和完好肩袖的患者的成熟方法。然而，是否aTSA或rTSA对于术前外旋（ER）力量削弱的患者提供了更好的疗效尚不清楚。我们回顾性评估了2007年至2020年期间一个前瞻性收集的肩关节置换数据库。患者被排除的标准包括术前诊断为神经损伤、感染、肿瘤或骨折。分析包括333例aTSA和155例rTSA，用于治疗肩袖完好的原发性骨关节炎，并进行至少2年的随访。将术前外旋力量（强度≤7.2磅）定义为术前力量削弱，创建并配对了3个队列：1）弱aTSA（n=74）与正常aTSA（n=74），2）弱rTSA（n=38）与正常rTSA（n=38），以及3）弱rTSA（n=60）与弱aTSA（n=60）。我们比较了最新随访时的活动范围、结果评分、力量、并发症和修复手术率。尽管弱aTSA在FE和ER方面的术前力量较差（P<0.001），但与正常队列相比，这些缺陷在术后都没有持续存在。同样，弱rTSA在FE和ER、上方活动以及Constant、SPADI和UCLA评分方面的术前力量较差（P<0.029）。然而，在术前弱和正常rTSA之间没有找到统计学上显著的差异。在比较术前弱的aTSA和rTSA时，我们发现在术前和术后的疗效、达到MCID和SCB的患者比例以及并发症和修复手术率方面都没有差异。在术前具有肩袖完好的原发性骨关节炎患者中，相对于术前力量正常的患者，在aTSA术后力量、活动范围和结果评分方面表现出类似的效果，表明术前力量削弱不排除使用aTSA的可能性。此外，术前ER力量较弱的患者在进行aTSA和rTSA后表现出改善的术后旋转运动，两组均以相似的速率达到了MCID和SCB。© 2023年Elsevier Inc.出版。

Anatomic and reverse total shoulder arthroplasty (aTSA, rTSA) are well-established treatments for patients with primary osteoarthritis and an intact cuff. However, it is unclear whether aTSA or rTSA provide superior outcomes in patients with preoperative external rotation (ER) weakness.A retrospective review of a prospectively collected shoulder arthroplasty database was performed between 2007-2020. Patients were excluded for preoperative diagnoses of nerve injury, infection, tumor, or fracture. Analysis included 333 aTSAs and 155 rTSAs performed for primary cuff-intact osteoarthritis with 2-year minimum follow-up. Defining preoperative ER weakness as strength ≤7.2 pounds, 3 cohorts were created and matched: 1) weak aTSAs (n = 74) vs normal aTSAs (n = 74), 2) weak rTSAs (n = 38) vs normal rTSAs (n = 38), and 3) weak rTSAs (n = 60) vs weak aTSAs (n = 60). We compared ROM, outcome scores, strength, complications, and revision rates at latest follow-up.Despite weak aTSAs having poorer preoperative strength in FE and ER (P<.001), neither of these deficits persisted postoperatively compared to the normal cohort. Likewise, weak rTSAs had poorer preoperative strength in FE and ER, overhead motion, and Constant, SPADI, and UCLA scores (P<.029). However, no statistically significant differences were found between preoperatively weak and normal rTSAs. When comparing weak aTSA versus weak rTSA, no differences were found in preoperative and postoperative outcomes, proportion of patients achieving the MCID and SCB, and complication and rate of revision surgery.In preoperatively weak patients with cuff-intact primary osteoarthritis, aTSA leads to similar postoperative strength, ROM, and outcome scores compared to patients with normal preoperative strength, indicating preoperative weakness does not preclude aTSA use. Furthermore, patients who were preoperatively weak in ER demonstrated improved postoperative rotational motion after undergoing aTSA and rTSA, with both groups achieving the MCID and SCB at similar rates.Copyright © 2023. Published by Elsevier Inc.