As pointed out in a prior post: Nobody with Shoulder Arthritis Comes In Asking For An ASES score of 80...Guess What They Do Ask For, surgeons frequently express arthroplasty outcomes as a number: for example, the ASES, SANE, VAS, SAS, or SSV score. While these numbers are of value in clinical research, they have little meaning to the patient considering shoulder joint replacement, who would rather know which of their lost functions they are likely to regain after surgery.
A recent paper, "Anatomic shoulder arthroplasty: a single surgeon’s consecutive series of four hundred and fifty eight patients" [1], shows how this can be done. The authors tracked patients having an anatomic total shoulder for cuff-intact arthritis performed by one surgeon using a basic technique: preoperative planning with plain films, subscapularis peel, conservative non-corrective glenoid reaming, an all-polyethylene glenoid component with an ingrowth central peg, and a standard-length humeral component, carried out under general anesthesia. Preoperative CT scans, nerve blocks, augmented glenoid components, structural bone grafting, navigation, and patient-specific instrumentation were not used.
A prospectively collected database identified 523 shoulders for inclusion. Sixty-five (12%) had less than two years of follow-up, 19 of them because the patient had died. That left 458 shoulders: mean age 64 years, 62% male, mean follow-up 6.7 years. Two hundred eight had five or more years of follow-up; 116 had ten or more.
Each patient's shoulder function was characterized before and sequentially after surgery by asking them to answer "yes" or "no" indicating whether or not they could perform each of the 12 functions of the Simple Shoulder Test (SST).
The mean number of "yes" answers on the SST increased from 3.3 to 9.2 of 12, a change of 5.9 points, or about 3.7 times the minimal clinically important difference (MCID) of 1.6. The mean percent of maximal possible improvement (%MPI) was 71%.
These are the data useful in clinical research.
For the patients, the item-level results are the more useful ones.
SST items before surgery (red) and at final follow-up (blue) [1].
Before surgery, only 8% could sleep comfortably; afterward, 86%. Twenty-one percent could tuck in a shirt; afterward, 81%. Twenty-nine percent could put a hand behind the head; afterward, 91%. Those are gains of 78, 60, and 62 percentage points in the three functions patients often name when they describe what the arthritis has taken from them.
All twelve functions improved (p < 0.0001 for each). The highest final rates were for comfort at rest (97%) and placing a coin on a shelf at shoulder height (94%). The lowest were for overhand throwing (44%) and lifting eight pounds overhead (57%); both were still substantial improvements from preoperative rates of 3% and 9%.
Two of the largest gains, tucking in a shirt and hand behind head, depend on the internal and external rotation that are hardest to recover after a reverse total shoulder. Lopez and colleagues found that internal rotation dysfunction and anterior shoulder pain were more common after reverse than after anatomic arthroplasty for osteoarthritis, differences that standard outcome instruments may not capture [2].
This information is useful in our discussions with patients considering shoulder joint replacement.
Other findings from the study are also of interest to prospective patients.
Durability
The mean SST reached 9.3 by two years and stayed there: at no later time point did it fall by as much as the MCID of 1.6. The number of shoulders at risk declined over time, as it must in any long series: 422 at two years, 311 at four, 257 at six, 182 at eight, and 116 at ten. Patel and colleagues found 97% survivorship at ten years, with SST improving from 4 to 8 [3]. In 202 patients aged 60 or under, Neyton and colleagues reported improvement in the Constant score from 37.5 to 73.3, although survivorship of their total shoulders declined more steeply after ten years [4].
Twelve shoulders (2.6%) had a reoperation: seven within the first two years, four between two and five years, and one between five and ten years. Six were for subscapularis failure, two for stiffness, one for infection, one for hematoma, and one for glenoid loosening; one was converted to a reverse at an outside hospital for reasons that were not determined.
Of note, glenoid loosening—the failure mode often cited as a reason to avoid an anatomic total shoulder—accounted for only one reoperation in this series.
Predictive factors
In multivariable regression (n = 389, R² = 0.16), better final SST was predicted by higher preoperative SST, male sex, higher preoperative optimism, no prior shoulder surgery, and no tobacco use. Age, BMI, VAS pain score, and a history of depression or anxiety were not significant predictors. Greater change in SST was predicted by lower preoperative SST (R² = 0.32): the patients with the least function had the most to gain. Two of the five predictors of the final result can be addressed before the incision: tobacco use and the patient’s expectation of benefit. However, it should also be noted that the model explains only 16% of the variance in final SST, so most of what determines how a given patient ends up is not captured by these variables.
Glenoid type
The Walch classification was available for 349 shoulders (76%): A1 16, A2 146, B1 28, B2 100, B3 52, D 7. Glenoid morphology did not significantly affect final SST (p = 0.40), SST change (p = 0.41), or %MPI (p = 0.20). Shoulders with B2 glenoids had the highest final SST of any subgroup (9.7) and the highest %MPI (75%). B2 and B3 glenoids combined (n = 152) compared with concentric A-type glenoids (n = 162) as follows: final SST 9.5 versus 9.1 (p = 0.18), change +6.5 versus +6.0 (p = 0.09), and %MPI 73% versus 67% (p = 0.05).
Two of the 152 shoulders with eccentric glenoids (1.3%) had a reoperation, compared with seven of the 162 with concentric glenoids (4.3%; p = 0.31).
This finding is of interest because B2 and B3 morphology is often used as a reason to choose a reverse, an augment, or a graft [5]; a matched-cohort analysis, however, found no difference in clinical outcomes, complications, or revision rates between anatomic and reverse arthroplasty for these glenoids [6].
What this study does and does not show prospective patients
It shows that in 458 consecutive shoulders operated on by one surgeon with a standard, non-augmented, all-polyethylene glenoid, patient-reported comfort and function improved by more than three times the MCID, improved in each of the twelve functions measured, reached a plateau at two years, and did not decline by as much as the MCID in the shoulders followed beyond ten years.
The limitations include:
These outcomes were observed in the practice of an individual experienced surgeon using a consistent method and may not be generalizable to other practices.
The study does not compare outcomes of anatomic and reverse shoulder arthroplasty for cuff-intact arthritis.
The study did not assess serial radiographs for the presence of radiolucencies.
The study did not show that glenoid morphology does not matter, only that no difference was detected in this series.
There was loss to follow-up: 65 shoulders were excluded for lack of two-year data. Nineteen of those patients had died; the status of the other 46 is not known.
Finally, reoperation may be an insensitive endpoint in patients who are elderly, medically unfit, or content to live with a painful shoulder.
The Bottom Line
Our primary responsibility is to our patients. They make decisions about having surgery based largely on the information provided by the surgeon. This information needs to be presented objectively and in terms that are easily comprehensible. Sharing data on what functions past patients could perform before and after a defined surgical procedure is one such approach. The data will be most relevant if they come from the practice of the operating surgeon because the surgeon is the method.
Building a better way to inform our patients
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References
1. Schiffman C, Chin E, Whitson A, Hsu J, Matsen FA III. Anatomic shoulder arthroplasty: a single surgeon’s consecutive series of four hundred and fifty eight patients. Int Orthop. Published online September 10, 2026. doi:10.1007/s00264-026-07017-5
2. Lopez R, Goltz D, Cox R, Yao JJ, Boufadel P, Lazarus M, Ramsey M, Namdari S. Comparison of anterior shoulder pain and internal rotation dysfunction after anatomic and reverse shoulder arthroplasty for osteoarthritis. J Shoulder Elbow Surg. 2025;34:2130-2137. doi:10.1016/j.jse.2024.12.027
3. Patel AV, White CA, Schroen CA, Cirino CM, Ranson WA, Shukla DR, Galatz LM, Parsons BO, Flatow EL, Cagle PJ. Anatomic total shoulder arthroplasty: long-term clinical, radiographic, and patient-reported outcomes. J Am Acad Orthop Surg. 2026;34(16):e2226-e2232. doi:10.5435/JAAOS-D-25-01121. PMID 41812257
4. Neyton L, Kirsch JM, Collotte P, Collin P, Gossing L, Chelli M, Walch G. Mid- to long-term follow-up of shoulder arthroplasty for primary glenohumeral osteoarthritis in patients aged 60 or under. J Shoulder Elbow Surg. 2019;28(9):1666-1673. doi:10.1016/j.jse.2019.03.006. PMID 31202630
5. Aleisawi H, Kruse C, Nucci N, Alturki N, Abdel Khalik H, Athwal GS, Khan M. Outcomes of anatomic versus reverse shoulder arthroplasty for B2 & B3 glenoids with an intact rotator cuff: an updated systematic review and proportional meta-analysis. Shoulder Elbow. Published online July 17, 2025. doi:10.1177/17585732251359590. PMID 40689354
6. Polisetty TS, Swanson DP, Hart PJ, Cannon DJ, Glass EA, Jawa A, Levy JC, Kirsch JM. Anatomic and reverse shoulder arthroplasty for management of type B2 and B3 glenoids: a matched-cohort analysis. J Shoulder Elbow Surg. 2023;32(8):1629-1637. doi:10.1016/j.jse.2023.02.125. PMID 36935078
