The retrospective study reports early to midterm total shoulder arthroplasty (traditional length stem, cemented glenoid) results for 267 patients (mean age of 70.9 years and mean clinical follow-up of 47 months).
The shoulders had an average glenoid retroversion of 9.7°, and 27% had eccentric glenoid wear.
At final follow-up, measured motion and nearly all patient-reported outcome measures showed significant improvements, with 75.6% of patients rating their satisfaction as excellent.
As we have pointed out previously (see "One and two-year clinical outcomes for a polyethylene glenoid with a fluted peg: one thousand two hundred seventy individual patients from eleven centers", see this link), the percent of maximal possible improvement is similar irrespective of the patient reported outcome scale.
No patient was considered “at risk” for humeral stem loosening, however the tight, canal filling humeral component may in some cases give rise to proximal stress shielding as shown in the radiograph below.
Medial calcar resorption and failure of healing of a lesser tuberosity osteotomy were noted in 60% and 24% percent of cases, respectively.
Glenoid radiolucencies were seen in 13.5% of shoulders (had 7 gross loosening).
The glenoid components noted to have radiographic lucency had been in place longer than those in place for a shorter period of time.
Five patients were revised to reverse TSA.
Comment: This study shows the importance of longer term followup after shoulder arthroplasty, in that problems such as medial calcar resorption and glenoid loosening may not be recognized until after 4 or more years after the total shoulder arthroplasty. This is particularly important in evaluating the incremental value of the many new systems being introduced into the marketplace. This will help us answer the question "Are the results of shoulder joint replacement improving (see this link)?"
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