We continue to probe the question - "what could have been done differently to reduce the risk of each patient experiencing shoulder arthroplasty failure" (see Recent JBJS article on failures (51%) of anatomic total shoulder arthroplasties)
A recent article, Why do primary anatomic total shoulderarthroplasties fail today? A systematic review and meta-analysis. reviewed 44 studies involving 35,168 aTSA procedures. 2,744 (one out of every 13) patients experienced failure of their arthroplasty. 21.7% of the failures were attributed to glenoid component loosening.
In their discussion, the authors state, "Glenoid loosening is a known late-term complication with radiolucency of the glenoid component commonly occurring at 5 years and progressing continually over time.
Despite advancements in implant design and surgical expertise, the rate of failures due to loosening remains unchanged, especially with the rise in augmented polyethylene glenoid components for advanced posterior glenoid erosion.
Failure of the glenoid component is likely due to multiple factors, some of which may be related to surgical technique or implant design, and others are likely patient-specific factors such as rotator cuff insufficiency or glenoid morphology."
This study defines the problem: too many patients are experiencing glenoid component failure, but does not provide a path forward.
Recognizing that when we look at a large series of failures, such as the one presented here, we are befuddled by the many factors that may contribute to failure. However, each failure occurs because of factors specific to that patient: the surgeon performing the procedure, the patient having the arthroplasty, the characteristics of the shoulder prior to surgery, the details of the procedure (surgical technique, implant selection), and the failure mode.
So, there is an opportunity to reduce the risk of failure in future arthroplasties by conducting case by case analyses of past failures. The goal of Shoulder Arthroplasty Failure Research is to implement a system for conducting these analyses and progressively adding analyzed cases to a surgeon-accessible de-identified, HIPAA-compliant library. As the library grows it has the potential for becoming an increasing valuable resource to inform the future care of patients with shoulder arthritis.
Learning from each case of failure
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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).
