Long-term functional and radiographic outcomes of anatomic total shoulder arthroplasty using an all-polyethylene cemented glenoid component with a minimum follow-up of 10 years.

Abstract

While anatomic total shoulder arthroplasty (aTSA) is a well-established procedure for the treatment of end-stage centered glenohumeral arthritis, only a few studies have reported the long-term outcomes of modern implants. The purpose of this study was to assess the long-term clinical, radiographic, and patient-reported outcomes after aTSA using a cemented glenoid polyethylene component. All consecutive procedures that involved implantation of aTSA in a single center between 03/2002 and 11/2014 were included. Clinical assessment and radiographic analysis were performed a minimum of 10 years postoperatively. Patient-reported outcome measures (Auto-Constant Score [CS], American Shoulder and Elbow Surgeons score, Subjective Shoulder Value, and visual analog scale for pain) were recorded. Complications and revision surgery were recorded, and revision-free implant survival was calculated at 10 years. Between 2002 and 2014, 134 procedures in 129 patients were identified. Of these, 56 procedures in 54 patients (55% female, 64 ± 10 years at surgery) were available for long-term follow-up at 12.4 years (10.9-14.7) postoperatively (response rate: 78%). During the total follow-up period, 14 patients (10.4%) underwent a revision after a median of 2.8 years (0.71-5.1). Implant survival at 10 years was 89% (95% confidence interval, 83%-95%). The overall complication rate was 16.4%. At final follow-up, favorable shoulder function was observed, with a CS of 63 (interquartile range, 54-69), an age- and sex-correlated CS of 83 (75-97), an American Shoulder and Elbow Surgeons score of 83 (76-92), n Subjective Shoulder Value of 80 (70-95), and low pain levels as indicated by a score of 0 (0-1.5). Moreover, a satisfactory range of motion was observed, with an anterior elevation of 160° (135°-170°), an abduction of 150° (110°-170°), and an internal rotation of T12 (L3-T12). Radiographic analysis was performed in 34 patients (60%). Superior migration of the humeral head was observed in 15 patients (44%), and medialization of the humeral head with a joint gap less than or equal to 0 mm was observed in 23 patients (68%). However, this was not associated with an inferior clinical or functional outcome. This study demonstrated favorable long-term clinical, functional, and radiographic outcomes of aTSA after 10 years. Although a high prevalence of radiographic signs associated with rotator cuff failure and glenoid wear were reported, this did not translate to a high complication rate or inferior outcome.