Shoulder joint arthroplasty in young patients: Analysis of 8742 patients from the Australian Orthopaedic Association National Joint Replacement Registry

Background Shoulder replacement is a reliable treatment for the relief of pain and improvement of function in patients with glenohumeral arthritis, rotator cuff arthropathy, osteonecrosis and fracture. Limited data is available comparing revision rates for the different types of shoulder replacement when used in younger patients. This study aims to compare the survivorship of hemi resurfacing, stemmed hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty in younger patients using data from a large national arthroplasty registry. Methods Data from the Australian Orthopaedic Association National Joint Replacement Registry was obtained for the period 16 April 2004–31 December 2018. The study population included all shoulder arthroplasty patients aged <65 years. These were stratified into two groups: <55 years and 55–64 years. A total of 8742 primary shoulder arthroplasty procedures were analysed (1936 procedures in the <55 years and 6806 in the 55–64 years age group). Results In the <55 years age group, there was no difference in revision rate for total shoulder arthroplasty versus reverse total shoulder arthroplasty at any time point. Reverse total shoulder arthroplasty had a lower revision rate after six months when compared to hemi resurfacing (HRA) (p = 0.031). Also, reverse total shoulder arthroplasty had a higher early rate of revision in the first 12 months compared to hemiarthroplasty (p = 0.018). However, from 2 years reverse total shoulder arthroplasty had a lower revision rate overall (p = 0.029). In the 55–64 years patient age group, reverse total shoulder arthroplasty had a lower earlier revision rate. This was statistically significant compared to hemi resurfacing (HRA) (p = 0.028), hemiarthroplasty (p = 0.049) and total shoulder arthroplasty (p < 0.001). Conclusion This study demonstrated that for patients aged <55 years there was no significant difference in the rate of revision when total shoulder arthroplasty and reverse total shoulder arthroplasty were compared. reverse total shoulder arthroplasty had a lower rate of revision when compared to hemi resurfacing and hemiarthroplasty after 2 years. reverse total shoulder arthroplasty had the lowest comparative revision rate in patients aged 55–64 years overall.

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CORR Insights®: A Comparison of Revision Rates for Osteoarthritis of Primary Reverse Total Shoulder Arthroplasty to Primary Anatomic Shoulder Arthroplasty with a Cemented All- polyethylene Glenoid: Analysis from the Australian Orthopaedic Association National Joint Replacement Registry

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000001924 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Eric T. Ricchetti

Keyword(s):

Joint Replacement ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Joint Replacement Registry ◽

Reverse Total Shoulder

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A Comparison of Revision Rates for Osteoarthritis of Primary Reverse Total Shoulder Arthroplasty to Primary Anatomic Shoulder Arthroplasty with a Cemented All-polyethylene Glenoid: Analysis from the Australian Orthopaedic Association National Joint Replacement Registry

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000001869 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

David R. J. Gill ◽

Richard S. Page BMedSci ◽

Stephen E. Graves ◽

Sophia Rainbird ◽

Alesha Hatton

Keyword(s):

Joint Replacement ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Joint Replacement Registry ◽

Reverse Total Shoulder

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Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-022-00625-y ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Hyojune Kim ◽

Chul-Ho Kim ◽

Minsoo Kim ◽

Wonsun Lee ◽

In-Ho Jeon ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Revision Rate ◽

Meta Analysis ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Functional Scores ◽

Reverse Total Shoulder ◽

Glenoid Loosening

Abstract Purpose We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. Materials and methods The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. Results Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = − 10.28, 95% CI: − 16.69 to − 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06–0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73–65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07–1.57, P = 0.16). Conclusion A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. Level of evidence: Level IV, Meta-analysis.

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Anatomic shoulder arthroplasty: an update on indications, technique, results and complication rates

Joints ◽

10.11138/jts/2015.3.2.072 ◽

2015 ◽

Vol 03 (02) ◽

pp. 72-77 ◽

Cited By ~ 9

Author(s):

Lorenzo Mattei ◽

Stefano Mortera ◽

Chiara Arrigoni ◽

Filippo Castoldi

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Scientific Community ◽

Total Shoulder Arthroplasty ◽

Persistent Pain ◽

Reverse Total Shoulder Arthroplasty ◽

Complication Rates ◽

Shoulder Replacement ◽

Reverse Total Shoulder ◽

Loss Of Strength

A shoulder replacement is indicated in patients affected by glenohumeral arthropathy with severely reduced range of motion, persistent pain, especially at night, and loss of strength. There is much discussion in the scientific community about the prosthetic options for these cases: hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. We analyzed the indications for, results of, and complications associated with this kind of surgery, focusing on anatomic arthroplasty and on the concept of modularity.

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An update on reverse total shoulder arthroplasty: current indications, new designs, same old problems

EFORT Open Reviews ◽

10.1302/2058-5241.6.200085 ◽

2021 ◽

Vol 6 (3) ◽

pp. 189-201

Author(s):

Thomas Kozak ◽

Stefan Bauer ◽

Gilles Walch ◽

Saad Al-karawi ◽

William Blakeney

Keyword(s):

Shoulder Arthroplasty ◽

Mixed Reality ◽

Total Shoulder Arthroplasty ◽

Computer Navigation ◽

Reverse Total Shoulder Arthroplasty ◽

Patient Specific ◽

Shoulder Replacement ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Reverse Total Shoulder

Reverse total shoulder arthroplasty (RTSA) was originally developed because of unsatisfactory results with anatomic shoulder arthroplasty options for the majority of degenerative shoulder conditions and fractures. After initial concerns about RTSA longevity, indications were extended to primary osteoarthritis with glenoid deficiency, massive cuff tears in younger patients, fracture, tumour and failed anatomic total shoulder replacement. Traditional RTSA by Grammont has undergone a number of iterations such as glenoid lateralization, reduced neck-shaft angle, modular, stemless components and onlay systems. The incidence of complications such as dislocation, notching and acromial fractures has also evolved. Computer navigation, 3D planning and patient-specific implantation have been in use for several years and mixed-reality guided implantation is currently being trialled. Controversies in RTSA include lateralization, stemless humeral components, subscapularis repair and treatment of acromial fractures. Cite this article: EFORT Open Rev 2021;6:189-201. DOI: 10.1302/2058-5241.6.200085

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Conversion to Reverse Total Shoulder Arthroplasty with and without Humeral Stem Retention: Mid-to Long-Term Results

Clinics in Surgery ◽

10.25107/cis-v6-id3277 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Marios Loucas ◽

Rafael Loucas ◽

Philipp Kriechling ◽

Samy Bouaicha ◽

Karl Wieser

Keyword(s):

Shoulder Arthroplasty ◽

Revision Rate ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Long Term Results ◽

Surgical Time ◽

Stem Revision ◽

Stem Retention ◽

Reverse Total Shoulder

Background: Over the past decade, conversion to Reverse Total Shoulder Arthroplasty (RTSA) has become the preferred treatment for revision of an Anatomic Hemi (HA) or Total Shoulder Arthroplasty (TSA). However, conversion of failed stemmed shoulder arthroplasty to RTSA is still a highly demanding procedure and carries unique technical challenges and risks. Questions/Purposes: This study aimed to analyze the mid- to long-term results after conversion of failed anatomical shoulder arthroplasty to RTSA and investigate whether preserving the humeral stem offers advantages over revising the humeral stem. Materials and Methods: Between 2005 and 2018, 99 hemiarthroplasties and 62 total shoulder arthroplasties (total =161 shoulders; 157 patients) were revised to RTSA without (n=47) or with (n=114) stem exchange. Complications and revisions were documented from medical and surgical records. Longitudinal pre- and post-operative clinical (Constant-Murley (CS) score, Subjective Shoulder Value (SSV)), and radiographic outcomes were assessed. Complete clinical and radiographic follow-up was available on 80% of shoulders (127 patients; 128 of 161 procedures, 46 without and 82 with stem exchange) at a minimum of 24 months and a mean of 70 months (range, 24 to 184 months). Results: Humeral stem retention was associated with a significantly reduced surgical time (193 min vs. 227 min, p=0.001, less blood loss (591 mL vs. 753 mL, p=0.037), less intraoperative complications (13% vs. 19%; Odds Ratio (OR), 1.4, p=0.32) and fewer subsequent reinterventions (19% vs. 28%; OR, 2.3, p=0.06). The complication/revision rate leading to drop out from the study was considerable in the stem revision group (ten patients; ten of 114 shoulders (9%)), but there were no complication-related dropouts in the stem-retaining group. Conclusion: Our findings suggest that humeral stem revision is associated with decreased surgical time, less blood loss, less intra- and postoperative complications, and a lower revision rate compared to humeral stem retention. Based on these findings, a shoulder arthroplasty system modularity offers substantial benefit if conversion to reverse total shoulder arthroplasty becomes necessary. Level of Evidence: Level III, therapeutic study.

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