Anatomic shoulder arthroplasty: a single surgeon's consecutive series of four hundred and fifty eight patients

Reverse total shoulder arthroplasty (rTSA) is increasingly performed for rotator cuff-intact glenohumeral arthritis, often justified by concerns about glenoid component longevity and rotator cuff failure after anatomic total shoulder arthroplasty (aTSA). The purpose of this study was to evaluate the durability of patient-reported outcomes and implant survivorship after aTSA in a large consecutive single-surgeon series.

Patients who underwent aTSA for rotator cuff-intact glenohumeral arthritis by a single surgeon with a minimum two year follow-up were included. Patient-reported outcomes were assessed using the Simple Shoulder Test (SST) and percentage of maximal possible improvement (%MPI) at multiple postoperative timepoints. Revision-free survivorship was estimated using Kaplan-Meier analysis.

458 shoulders (mean age 64.2 ± 11.9 years; 62% male; mean follow-up 6.7 ± 3.9 years) were included. Mean SST improved from 3.3 ± 2.7 preoperatively to 9.2 ± 2.7 at final follow-up (p < 0.001; %MPI = 71.2 ± 29.8%). SST scores plateaued by two years and did not decline at any subsequent timepoint. Revision surgery was required in 12 patients (2.6%) with no difference based on Walch type (B2/B3 1.3% vs A1/A2 4.3%, p = 0.307). Most revisions occurred within the first two years due to subscapularis failure.

aTSA produced clinically significant and durable improvements in patient-reported function sustained beyond ten years, with a low overall revision rate. These findings support aTSA as an effective treatment for rotator cuff-intact glenohumeral arthritis across a broad range of glenoid morphologies.