Anatomic total shoulder arthroplasty outcomes and implant survivability at greater than 22 years postoperative follow-up: A case series

Abstract

Background: The modern anatomic shoulder implant has been available for five decades. Multiple short-to mid-term studies have reported favorable outcomes and predicted implant survival rates two decades post operatively. Yet, few studies have characterized the long-term (i.e., >20 years) clinical outcome expectations following shoulder replacement. Case details: In this case series, five patients underwent anatomic total shoulder arthroplasty for severe glenohumeral osteoarthritis with an average follow-up time of 25.4 years. The average postoperative Visual Analog Score, American Shoulder and Elbow Surgeon, and Simple Shoulder Test scores were 2.4/10.0, 61.7/100.0, and 7.0/12.0 respectively. Each patient saw improved range of motion outcomes that were at or below reported minimal clinically important differences. Glenoid loosening was present in two patients and humeral lucency was absent in all patients with available radiographic images (n ​= ​4). One shoulder required revision to reverse shoulder arthroplasty due to painful glenoid loosening 20.0 years after their primary anatomic replacement. Implant survival was 80% at 20-years and the mean implant survival time was predicted to be 28.0 ​± ​1.8 years. Conclusion: Anatomic total shoulder arthroplasty is a viable option for end stage osteoarthritis at long-term follow-up. However, patient expectations need to be curtailed as clinical outcomes will become lower as the implant ages and, subsequently, revision surgery will grow increasingly probable