We review their recent report on the use of total shoulder joint replacement. There were 40,130 total shoulder replacements reported to the Registry.
The cumulative percent revision of primary anatomic total stemmed shoulder replacements for osteoarthritis was 14.8% at 12 years. There was no difference in the rate of revision when osteoarthritis was compared to fracture and osteonecrosis. Rheumatoid arthritis had a lower rate of revision compared to osteoarthritis.
The Registry recorded 1,055 revisions of primary total stemmed shoulder replacements. Rotator cuff insufficiency was the most common reason for revision of primary total stemmed shoulder replacement. It accounted for 24.7% of all revisions, followed by instability/dislocation (21.9%) and loosening (17.5%). The cumulative incidence of the five most common reasons for revision are presented in the figure below.
The revision rate was highest for cementless glenoids. Cementless fixation had a higher rate of revision compared to both cemented and hybrid (glenoid cemented) fixation.
A further analysis was undertaken to determine the impact of glenoid type. There were three broad glenoid types: modular metal backed, non modular metal backed and all-polyethylene. All-polyethylene glenoid prostheses were used in 71.6% of primary total stemmed shoulder replacements, the majority of which were cemented (99.5%). These prostheses have a lower rate of revision compared to modular metal backed glenoid over the entire period and non modular metal backed glenoid prostheses in the first 3 months. A modular metal backed glenoid has a higher rate of revision compared to a non modular metal backed glenoid.
Pegged and keeled all-polyethylene glenoid prostheses were also compared. The majority of all-polyethylene glenoid prostheses were pegged (86.8%). There was no difference in the rate of revision between these prostheses.
The use of cross-linked polyethylene (XLPE) glenoids increased from 10.7% in 2008 to 32.5% in 2018. When the SMR L2 glenoid prosthesis is excluded, XLPE glenoids have a lower cumulative percent revision at 10 years compared to non XLPE glenoids (4.3% compared to 11.5%, respectively)
This is also the case when only all-polyethylene glenoids are compared.
Comment: These are very important data for several reasons:
(1) They come from a broad-based national population of patients and surgeons, rather than from the practices of specialists or major centers.
(2) They are free of the conflicts of surgeon interest that confound the interpretation of level IV case series.
(3) They indicate that an XLPE all-polyethylene, cemented glenoid component has a 10 year survivorship of greater than 95% for patients with glenohumeral osteoarthritis.
(4) The preponderance of the long term follow-up data come from shoulders inserted before the recent enthusiasm for 3D planning and patient-specific instrumentation.
(5) These data indicate that these new technologies will need to be very effective in order to have a demonstrable and cost-effective impact on total shoulder survivorship in cases of osteoarthritis.
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