Glenohumeral osteoarthritis - what type of arthroplasty has the lowest 10 year revision rate?

Total Shoulder Replacement Stems in 1 Osteoarthritis – short, long or reverse? An analysis of the impact of cross-linked polyethylene.

In their analysis of different types of total shoulder arthroplasty for osteoarthritis (OA) in the 2021 Australian Orthopaedic Association National Joint Replacement Registry (see this link), these authors considered five implant types separately: 

(1) stemmed anatomic total shoulder arthroplasty (aTSA) with metaphyseal or diaphyseal humeral component fixation with either cross-linked polyethylene ("total stemmed XLPE") or non-cross-linked polyethylene ("total stemmed non XLPE")

(2) stemless anatomic total shoulder arthroplasty with epiphyseal fixation with either cross-linked polyethylene ("total mid head XLPE") or non-cross-linked polyethylene ("total mid head non XLPE")

and 

(3) reverse total shoulder arthroplasty ("total reverse").

Due to the previously documented higher revision rate compared to other anatomic total shoulder replacement options, those arthroplasties using a cementless metal backed glenoid components were excluded.

Of note, this registry provided data on a substantial number of shoulders many years out from their index arthroplasty.

For the primary diagnosis of OA, aTSA with a cemented XLPE glenoid component had the lowest revision rate with a 12-year cumulative revision rate of 4.7%, compared to aTSA with cemented non-XLPE glenoid component of 8.7%, and RTSA of 6.8%. 

The principal reason for revision for the total stemmed non XLPE was component loosening.

The lower rate of revision for component loosening with cross-linked polyethylene is shown below.

Comment: In this large national database study of 28,467 primary total shoulder replacement procedures the best 10 year survivorship was seen for anatomic stemmed total shoulder replacement with a cemented cross-linked polyethylene glenoid component in comparison to reverse total shoulder and in comparison to anatomic arthroplasty with a non cross-linked polyethylene glenoid component. Results in this study for short or mid head stems were inconclusive, but initial indications were that they were not substantially better than the long stem implants utilizing crosslinked polyethylene.

We are reminded that in reading studies of arthroplasty revision rates, it is important to understand whether the study includes metal back glenoids or glenoid components with non cross-linked polyethylene.

This study of arthroplasties by all surgeons in Australia found a 10 year cumulative percent revision rate of 4.1 percent for anatomic stemmed total shoulder replacements with a cemented cross-linked polyethylene glenoid component. This is an important benchmark against which reverse total shoulder arthroplasty and future shoulder arthroplasty innovations should be compared.

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).